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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Ophthalmology

Treatment Pathways: Protecting Your Baby's Vision

At a Glance

The two primary treatments for severe Retinopathy of Prematurity (ROP) are laser therapy and anti-VEGF injections. Laser therapy is usually permanent but may affect peripheral vision, while injections preserve the whole retina but require long-term weekly monitoring for possible disease recurrence.

If your baby is diagnosed with Type 1 ROP (treatment-requiring ROP), it means the risk of vision loss is high enough that the medical team needs to intervene [1][2]. Because ROP can progress quickly, especially in its most aggressive forms, treatment is typically planned and performed as soon as possible, often within 48 to 72 hours of the diagnosis [2][3].

There are two primary standard-of-care treatments for ROP: Laser Photocoagulation and Anti-VEGF Injections. Both aim to stop the growth of abnormal blood vessels, but they do so in different ways [4].

Laser Photocoagulation

For many years, laser therapy has been the “gold standard” for treating ROP. The doctor uses a laser to “burn” or ablate the outer edges of the retina where blood vessels haven’t grown yet [4][5].

  • How it works: By destroying the “hungry” part of the retina that is sending out emergency growth signals, the laser stops the production of VEGF (the growth factor), causing abnormal vessels to shrink [4][5].
  • Pros: It is a permanent solution with a very low rate of the disease coming back [6][7].
  • Cons: Because it destroys the peripheral (side) retina, it can lead to a loss of some side vision and increases the risk of severe myopia (nearsightedness) later in life [8][9].

Anti-VEGF Injections

This is a newer treatment where a small amount of medication (such as bevacizumab or ranibizumab) is injected directly into the eye [10][11].

  • How it works: The drug acts like a sponge, soaking up the excess VEGF signals in the eye. This causes the abnormal vessels to regress very quickly—often faster than with laser [4][11]. It is usually given as a one-time injection per eye, though sometimes additional treatments are needed if the disease comes back [11][6].
  • Pros: It preserves the entire retina (no “burns”), allows for better side vision, and is often faster and easier to perform at the bedside [12][8]. It is often the preferred choice for ROP in Zone I [12].
  • Cons: The biggest risk is late recurrence (reactivation) [6][13]. Because the drug eventually leaves the body, the disease can “wake up” weeks or even months later. This requires a much longer and more intense follow-up schedule—often requiring weekly exams well past your baby’s original due date, sometimes up to 60-65 weeks Postmenstrual Age (PMA) [14][13].
Feature Laser Therapy Anti-VEGF Injections
Permanence Usually permanent [6] Temporary; can wear off [14]
Side Vision Some loss of side vision [8] Preserves side vision [12]
Nearsightedness Higher risk [9] Lower risk [8]
Follow-up Shorter monitoring period [6] Long-term, intense monitoring (up to 60-65 weeks PMA) [13]

Surgical Intervention (Vitrectomy)

If ROP progresses to Stage 4 or 5, it means the retina has started to detach. In these advanced cases, laser or injections are no longer enough, and a surgery called a vitrectomy may be necessary [15][16].

During a vitrectomy, a retinal surgeon removes the gel inside the eye and clears away the scar tissue that is pulling on the retina [15][17]. While this surgery can help save vision, the outcomes for advanced stages are generally more challenging than for cases caught and treated early [15][18].

The Timing of Care

Regardless of the treatment chosen, timing is critical. Your baby’s care team will work to balance the need for treatment with your baby’s overall stability [2]. Once a decision is made, the goal is to stop the progression of the disease before it can cause permanent structural damage to the eye [4][3]. After any treatment, whether laser or injection, your baby will still need regular eye exams to ensure their eyes are healing properly [19][20].

Common questions in this guide

What are the main treatments for Type 1 ROP?
The two primary treatments for Type 1 ROP are laser photocoagulation and anti-VEGF injections. Both aim to stop the growth of abnormal blood vessels in the retina before they can cause permanent structural damage to the eye.
How do anti-VEGF injections for ROP work?
Anti-VEGF medications are injected directly into the eye to soak up excess growth signals causing abnormal blood vessels. This makes the abnormal vessels shrink quickly and preserves side vision, but it requires intense, long-term monitoring for potential disease reactivation.
What are the risks of laser therapy for ROP?
Laser therapy treats ROP by burning the edges of the retina to stop abnormal vessel growth. While this is usually a permanent fix, destroying the side portions of the retina can lead to some loss of peripheral vision and an increased risk of severe nearsightedness later in life.
How long will my baby need follow-up exams after ROP treatment?
If your baby receives laser therapy, the monitoring period is typically shorter. However, if they receive anti-VEGF injections, the medication can wear off and the disease can reactivate, often requiring weekly exams up to 60 or 65 weeks postmenstrual age.
What happens if ROP causes the retina to detach?
If ROP progresses to Stage 4 or 5 and the retina begins to detach, laser therapy or injections are no longer sufficient. A retinal surgeon may need to perform a procedure called a vitrectomy to clear away scar tissue and help save your baby's vision.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my baby's ROP located in Zone I or Zone II, and how does that influence which treatment you recommend?
  2. 2.If we choose anti-VEGF injections, how long will my baby need frequent follow-up exams to watch for "late recurrence"?
  3. 3.What are the risks and benefits of laser therapy versus injections specifically for my baby's current stage?
  4. 4.If treatment is needed today, what is the exact timeline for the procedure, and will it happen here in the NICU or in an operating room?
  5. 5.If we start with one treatment and it doesn't work, what is the "Plan B"?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity.

    Seery CW, Betesh S, Guo S, et al.

    Journal of pediatric ophthalmology and strabismus 2020; (57(6)):351-362 doi:10.3928/01913913-20200824-02.

    PMID: 33211892
  2. 2

    Screening Examination of Premature Infants for Retinopathy of Prematurity.

    Fierson WM, , , et al.

    Pediatrics 2018; (142(6)) doi:10.1542/peds.2018-3061.

    PMID: 30478242
  3. 3

    Anti-vascular endothelial growth factor intravitreal therapy for retinopathy of prematurity.

    VanderVeen DK, Cataltepe SU

    Seminars in perinatology 2019; (43(6)):375-380 doi:10.1053/j.semperi.2019.05.011.

    PMID: 31174872
  4. 4

    Retinopathy of Prematurity: Evolving Treatment With Anti-Vascular Endothelial Growth Factor.

    Hartnett ME

    American journal of ophthalmology 2020; (218()):208-213 doi:10.1016/j.ajo.2020.05.025.

    PMID: 32450064
  5. 5

    Management of aggressive posterior retinopathy of prematurity in oculocutaneous albinism.

    Panchal B, Gulati M

    BMJ case reports 2021; (14(2)) doi:10.1136/bcr-2020-238490.

    PMID: 33526528
  6. 6

    Recurrence of Retinopathy of Prematurity Following Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy: A Systematic Review and Meta-Analysis.

    Dablouk M, Chhabra A, Masoud AT

    Cureus 2024; (16(11)):e73286 doi:10.7759/cureus.73286.

    PMID: 39524166
  7. 7

    Effect of Ranibizumab in Patients with Treatment-Naïve Retinopathy of Prematurity.

    Khalid H, Malik TG, Amjad A, et al.

    Turkish journal of ophthalmology 2025; (55(4)):200-206 doi:10.4274/tjo.galenos.2025.77992.

    PMID: 40838511
  8. 8

    FIVE-YEAR VISUAL OUTCOME OF TREATMENT FOR RETINOPATHY OF PREMATURITY IN INFANTS WEIGHING <500 G AT BIRTH: A Multicenter Cohort Study From J-CREST.

    Tomioka M, Murakami T, Okamoto F, et al.

    Retina (Philadelphia, Pa.) 2024; (44(4)):652-658 doi:10.1097/IAE.0000000000004016.

    PMID: 38064668
  9. 9

    OUTCOMES AFTER LASER VERSUS COMBINED LASER AND BEVACIZUMAB TREATMENT FOR TYPE 1 RETINOPATHY OF PREMATURITY IN ZONE I.

    Yoon JM, Shin DH, Kim SJ, et al.

    Retina (Philadelphia, Pa.) 2017; (37(1)):88-96 doi:10.1097/IAE.0000000000001125.

    PMID: 27347645
  10. 10

    Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone.

    Mueller B, Salchow DJ, Waffenschmidt E, et al.

    The British journal of ophthalmology 2017; (101(3)):365-370 doi:10.1136/bjophthalmol-2016-308375.

    PMID: 27301450
  11. 11

    Different effects of various anti-angiogenic treatments in an experimental mouse model of retinopathy of prematurity.

    Heiduschka P, Plagemann T, Li L, et al.

    Clinical & experimental ophthalmology 2019; (47(1)):79-87 doi:10.1111/ceo.13368.

    PMID: 30073769
  12. 12

    Preferred Treatment Patterns of Retinopathy of Prematurity: An International Survey.

    Wang AT, Dai S

    Pediatric reports 2024; (16(3)):816-822 doi:10.3390/pediatric16030069.

    PMID: 39311332
  13. 13

    Reactivation of retinopathy of prematurity six years after intravitreal injection of bevacizumab.

    Yasin A, Sinha S, Smith R, et al.

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2023; (27(4)):236-239 doi:10.1016/j.jaapos.2023.05.008.

    PMID: 37451499
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    Anti-Vascular Endothelial Growth Factor Therapy for Primary Treatment of Type 1 Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology.

    VanderVeen DK, Melia M, Yang MB, et al.

    Ophthalmology 2017; (124(5)):619-633 doi:10.1016/j.ophtha.2016.12.025.

    PMID: 28341474
  15. 15

    Long-term follow-up after lens-sparing vitrectomy for complications of retinopathy of prematurity.

    Gopal L, Bhende P, Rao C, et al.

    Indian journal of ophthalmology 2025; (73(Suppl 1)):S132-S138 doi:10.4103/IJO.IJO_179_24.

    PMID: 39257102
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    [National protocol for diagnosis and care of retinopathy of prematurity: Summary for the attending physician].

    Daruich A, Bremond-Gignac D, Aziz A, et al.

    Journal francais d'ophtalmologie 2025; (48(1)):104333 doi:10.1016/j.jfo.2024.104333.

    PMID: 39454240
  17. 17

    Current concepts and techniques of vitrectomy for retinopathy of prematurity.

    Kusaka S

    Taiwan journal of ophthalmology 2018; (8(4)):216-221 doi:10.4103/tjo.tjo_102_18.

    PMID: 30637193
  18. 18

    Long-term results of surgery for retinal detachment due to retinopathy of prematurity.

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    Indian journal of ophthalmology 2025; (73(11)):1670-1674 doi:10.4103/IJO.IJO_1414_25.

    PMID: 41148021
  19. 19

    Caregiver Impact and Understanding of Retinopathy of Prematurity Screening.

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    PMID: 41049119
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    Knowledge, Attitudes and Practices of Health Workers and Caregivers Towards Retinopathy of Prematurity in Uganda: A Mixed-Methods Study.

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This page explains Retinopathy of Prematurity (ROP) treatment options for educational purposes. Always consult your baby's neonatologist and pediatric ophthalmologist for personalized medical advice and treatment planning.

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