- Design
- AAO Ophthalmic Technology Assessment (systematic evidence review)
- Population
- 26 studies (3 RCTs, 22 cohorts) of infants treated for ROP, 2006–2022, 39 countries
- Primary outcome
- Neurodevelopmental outcomes after anti-VEGF vs laser
- Effect
- 20/26 studies (77%), including all RCTs, found no significant difference; 4 worse with bevacizumab, 2 worse with laser
Whether intravitreal anti-VEGF for retinopathy of prematurity affects brain development, because of systemic VEGF suppression, has shadowed the choice between injection and laser. This American Academy of Ophthalmology evidence assessment, published in July, reviewed 26 studies: four reports of three randomised trials (level II) and 22 comparative cohorts (level III), from 39 countries.
Most studies (77%), including all the randomised trials, found no significant difference in neurodevelopmental outcomes. Four found worse outcomes after bevacizumab and two after laser. Only five tested IQ beyond four years, and none found a difference. No study was powered to detect small differences.
India screens and treats large numbers of premature infants for ROP, often with bevacizumab because of cost. The review supports continuing to choose between injection and laser on ocular grounds, with honest counselling that small neurodevelopmental effects cannot be excluded.
- Choose between anti-VEGF and laser for ROP on ocular and logistic grounds; neurodevelopmental data do not favour either.
- Tell parents that no consistent developmental harm has been shown, but small effects cannot be ruled out.
- Ensure every treated infant has neurodevelopmental follow-up through the neonatal or paediatric team.
- Remember that anti-VEGF-treated eyes need longer ROP follow-up for late reactivation.
Why it matters
It addresses the main systemic worry about injecting premature infants, which often drives treatment choice.
Don't overread it
No study was powered for neurodevelopmental outcomes; 'no difference found' is not proof of no difference.
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