Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity

Abstract

To characterize visual outcomes in children screened for retinopathy of prematurity (ROP). Retrospective, interventional case series. Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older. A total of 175 infants (350 eyes) were included for analysis (mean gestational age=28.2 weeks and birth weight=1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR]=0.6-0.86, P < .0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P=.79), strabismus (P=.98), and myopia (P=.93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P=.041). Infants receiving laser therapy were more likely to have severe myopia (aOR=1.02-1.3, P=.023), amblyopia (aOR=1.12-1.61, P=.002), and optic atrophy (aOR=1.01-1.32, P=.045) than infants not treated. These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.