Shedding Light on Infant Eye Health: How Anti-VEGF Treatments are Minimizing Myopia Risk in Premature Babies
"Discover how a new approach is changing the landscape of refractive error correction for premature infants, potentially leading to better vision outcomes."
Advances in treating Retinopathy of Prematurity (ROP) are drastically improving anatomical and functional outcomes, offering new hope in preventing blindness from retinal detachment. Anti-VEGF agents, a recent addition to the ROP-treatment toolkit, are showing significant clinical benefits, including a reduction in the rates of high and very high myopia following treatment, compared to traditional peripheral ablation.
Historically, treatments like cryotherapy and laser ablation, while effective in addressing ROP, often led to the development of high and very high myopia. This was often attributed to the severity of ROP itself, rather than the treatments. Interestingly, milder forms of myopia, termed 'myopia of prematurity,' are also seen in premature children without ROP and those with spontaneously regressing ROP.
This review explores the key causative factors that contribute to refractive errors in children treated with anti-VEGF agents for ROP. By understanding these factors, we can better optimize treatment strategies and improve visual outcomes for these vulnerable infants.
ROP Treatment and Refractive Outcomes
The cited Frontiers article is titled “Refractive outcomes following anti-VEGF ...” and its supplied snippet identifies the broader topic as an update on retinopathy of prematurity (ROP) pathophysiology, diagnosis, and treatment. The snippet does not provide specific treatment comparisons, refractive outcome figures, or limitations, so those details cannot be established from this source material.
How ROP Came to Be Understood
Retrolental fibroplasia (RLF) was renamed retinopathy of prematurity (ROP) as research came to understand prematurity and the immaturity of the eye as the primary cause, with the condition developing after birth renaissance.stonybrookmedicine.edu. ROP occurs when retinal vessels have not completed their normal growth before birth, and its development includes delayed physiologic vascular development that damages newly formed capillaries eyewiki.org. Today, screening aims to reduce unnecessary examinations while still detecting at-risk infants so they can receive treatment; the National Eye Institute notes that ROP can affect babies born early or weighing less than 3 pounds, and some need treatment to protect vision nei.nih.gov.
Anti-VEGF Treatment: A New Era for ROP and Refractive Error
A comprehensive review of available literature, focusing on the effects of anti-VEGF agents on refractive error within the context of ROP, was conducted using PubMed. The search included terms like 'retinopathy of prematurity,' 'ROP,' 'refraction,' 'myopia,' and specific anti-VEGF drugs such as 'bevacizumab,' 'ranibizumab,' and 'aflibercept.'
- The average SE refractive error reported after anti-VEGF monotherapy ranged from +0.75 D to -3.57 D.
- The average age at the time of refraction in these studies ranged from 11.4 months to 5 years.
- Different anti-VEGF agents may yield different prevalence of high myopia, with intravitreal bevacizumab yielding high myopia in 8%-35% of eyes versus 0 following intravitreal ranibizumab treatment.
Evolving ROP Care
A review of ROP management reports that anti-vascular endothelial growth factor (anti-VEGF) treatments have revolutionized care. A 2025 review describes advances in screening, imaging, diagnosis, and medical and surgical treatment, and states that screening is required for infants born before 30 weeks’ gestation or weighing less than 1500 g. Another review notes that continuing research is refining clinical clues used to evaluate infants with ROP while advancing technologies improve diagnostic accuracy and timely treatment.
Comparing Laser and Anti-VEGF
Laser therapy and intravitreal anti-VEGF injections, alone or in combination, are current mainstays for treating type 1 ROP. A 2026 study describes comparative outcome data as heterogeneous and limited by short-term follow-up, with limited information on visual acuity after treatment. Other supplied sources identify mortality and neurodevelopmental outcomes as areas of comparison between anti-VEGF and laser, but their snippets provide no results that establish which treatment is preferable.
The Future of ROP Treatment: Minimizing Myopia and Maximizing Vision
Intravitreal anti-VEGF agents represent a significant advancement in the treatment of ROP, offering the potential to minimize myopia and decrease the incidence of high myopia compared to traditional retinal laser ablation.
Monitoring After Treatment
ROP is a neurovascular retinal disease in newborns that can lead to vision deficits or blindness, particularly among preterm infants who require intensive neonatal care. A review of treatment reports that fibrovascular patterns after anti-VEGF differ from those seen after laser in infants who later develop retinal detachments. It emphasizes close monitoring of early fibrovascular activity that may signal detachment, to help identify the opportunity for surgery and weigh its risks and benefits.
Timely Care and Prevention
ROP results from abnormal retinal vascularization and can cause retinal detachment and severe long-term vision impairment if it is not detected and treated promptly. Early diagnosis and appropriate treatment can prevent vision loss, improve quality of life, and support a child’s overall development. High-quality neonatal intensive care is also critical to preventing ROP among high-risk premature infants.
Treatment Outcomes in Practice
A real-world study compared laser and anti-VEGF treatment for ROP over a 9-year period. It found an association between laser treatment and the development of severe myopia, amblyopia, and optic atrophy, describing these as adverse visual effects. A separate 2021 study described a single neonatal-unit cohort in which two oxygen-saturation limits were administered, examining real-world outcomes in the context of a trend toward higher oxygen to improve survival.
While these outcomes are promising, further research is needed to address key aspects of this therapy, including long-term refractive and visual outcomes, long-term safety, optimal dosage, and the best specific anti-VEGF agent for each patient.
By continuing to investigate and refine anti-VEGF treatment strategies, we can move closer to a future where premature infants with ROP have the best possible chance for a lifetime of clear vision.