Current and Emerging Treatment

While the majority of cases of retinopathy of prematurity (ROP) improve without treatment, the presence of plus disease, Type 1 ROP or aggressive ROP (A-ROP) requires transition from observation to treatment for prevention of vision loss.1-3 Intervention should commence within 72 hours of detection of treatable disease to reduce the risk for retinal detachment.3 Treatment is most often required between 34-38 weeks of gestation.4

The treatment of ROP is a collaboration among ophthalmologists, pediatricians, neonatologists, and other health professionals.1,3 Potential modalities include laser therapy, cryotherapy, surgery, or the use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents.1,5 Other supportive treatments may be needed, including the use of eyeglasses, the use of an eye patch, or future eye surgeries.1

Cryotherapy and laser photocoagulation

Treatments aimed at ablation of the avascular, peripheral retina include cryotherapy as well as argon and diode laser photocoagulation.1,2,5 Post-treatment followup is recommended within 3-7 days for assessment of regression and reactivation.5 Although cryotherapy was the first treatment for ROP, laser is preferred due to portability and better tolerability.5 Treatment with either modality can prevent or reverse abnormal vessel proliferation, but may result in in loss of some peripheral vision.1

Intravitreal anti-VEGF

An emerging treatment to suppress abnormal vessel growth, which can be used as monotherapy or in addition to laser treatment.4,8 Post-injection follow-up includes monitoring for endophthalmitis and reexamination ≤7 days to ensure reduction in ROP features.5 Studies have shown promise for treatment of zone I, stage 3 ROP with plus disease, as well as type 1 ROP; bevacizumab and ranibizumab, and aflibercept have all demonstrated efficacy in treating ROP.5,9-13 In fact, aflibercept received US Food and Drug Administration (FDA) approval in early 2023 (FIREFLEYE and BUTTERFLEYE studies), making it the first anti-VEGF therapy to receive an approved indication for the pharmacologic treatment of premature infants with ROP.14 Results of various studies are encouraging, with continued research underway to determine long-term safety, optimal dosing and rates of ROP recurrence.8

Vitrectomy and scleral buckle

Later stages of ROP with subsequent retinal detachment may require support with scleral buckling or repair via vitrectomy.1 Scleral buckles may need to be divided within months to years to prevent myopia with continued growth of the eye.15 In newborns, treatment of a serious retinal detachment may not have much benefit in restoring vision.1

Outcomes of laser or intravitreal injection treatment for ROP is usually favorable with disappearance of abnormal vasculature and resolution of plus disease.8 However, despite accurate diagnosis and timely treatment, ROP may sometimes continue to worsen and progress to retinal detachment, with subsequent poor visual prognosis.8 Among infants who weigh less than 750g at birth (micropreemie), 16% to 20% will require treatment and approximately 5% will be blind despite best intervention.1,18


  1. NORD Rare Disease Database. Retinopathy of Prematurity.
  2. American Society of Retina Specialists (ASRS). RetinaAtlas. Retinopathy of prematurity (ROP).
  3. Fierson WM, American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142:e20183061.
  4. ASRS. Retina Health Series. Retinopathy of Prematurity.
  5. Heidar K. Retinopathy of prematurity. EyeWiki®. Last reviewed May 30, 2022.
  6. Ruan L, Shan HD, Liu XZ, Huang X. Refractive status of Chinese with laser-treated retinopathy of prematurity. Optometry and Vision Science: Official Publication of the American Academy of Optometry. 2015;92(4 Suppl 1):S3-S9.
  7. Hansen ED, Hartnett ME. A review of treatment for retinopathy of prematurity. Expert Rev Opthhalmol. 2019;12:73-87.
  8. American Academy for Pediatric Ophthalmology and Strabismus. Retinopathy of Prematurity.
  9. Eftekhari Milani A, Bagheri M, Niyousha MR, et al. Comparison of clinical outcomes of intravitreal bevacizumab and aflibercept in type 1 prethreshold retinopathy of prematurity in posterior zone II. J Curr Ophthalmol. 2022;34:87-92.
  10. Wallace DK, Dean TW, Hartnett ME, et al. A dosing study of bevacizumab for retinopathy of rematurity: Late recurrences and additional treatments. Ophthalmology. 2018;125:1961-1966.
  11. Stahl A, Lepore D, Fielder A, et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): An open-label randomised controlled trial. Lancet. 2019;394:1551-1559.
  12. Chen PJ, Rossin EJ, Vavvas DG. Aflibercept for retinopathy of prematurity: A systemic review and meta-analysis. Ophthalmic Surg Lasers Imaging Retina. 2021;52:673-681.
  13. Vural A, Perente İ, Onur İU, et al. Efficacy of intravitreal aflibercept monotherapy in retinopathy of prematurity evaluated by periodic fluorescence angiography and optical coherence tomography. Int Ophthalmol. 2019;39:2161-2169.
  14. Press Release. Aflibercept (Eylea®). February 8, 2023.
  15. Hong EH, Shin YU, Clo HC. Retinopathy of prematurity: a review of epidemiology and current treatment strategies. Clin Exp Pediatr. 2022;65:115-126.
  16. Devgiri Memorial Superspecialty Eye Clinic. Scleral buckle retina surgery.
  17. Yannuzzi NA, Prakhunhungsit S, Berrocal AM. Retinal surgery in adult patients with history of prematurity. Retinal Physician. January 1, 2019.
  18. Medical Dictionary. Micropreemie. 2009 Farlex and partners.

 All URLs accessed 7/1/22.

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Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX



Clinician Scientific & Educational Resources

The RELIEF Clinical Toolkit is an online tool that aims to provide clinicians with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for retinopathy of prematurity (ROP). Click on one of the options below to learn more about ROP.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM). This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.

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