R.V. Paul Chan, MD, FACS

In the management of retinopathy of prematurity there is still an ongoing conversation regarding how best to use anti-VEGF therapy for surgery and in the treatment of aggressive forms of ROP.

Paola Dorta, MD’s, discussion was excellent. She and Andres Kychenthal, MD, have significant experience with ROP and using anti-VEGF therapy for this condition. Regional differences in ROP care should be considered. For example, now that we are in this era of having anti-VEGF as a treatment option, can we treat ROP the same way in every country? Although we are using anti-VEGF treatment for ROP, we are still trying to figure out the best way to use it and the best indications for its use. Questions still remain for it being used as a primary treatment for all cases of treatment-requiring ROP vs. doing laser as primary treatment or a combination of laser and anti-VEGF.

We must be cautious in saying that anti-VEGF treatment is the solution for all cases of treatment requiring ROP. In resource poor settings, however, where there is no access to laser, anti-VEGF may be the only treatment available. It is critically important to understand all the issues around anti-VEGF as primary treatment. You need to appropriately follow the child after injection, identify progression and recurrence of disease, and being able to perform these injections does not obviate the need for knowing how to do laser or indirect ophthalmoscopy. Laser may be necessary for cases of recurrence or incomplete vascularization.

Dorta and Kychenthal have experience with this and have the ability to manage the potential complications after injection. If you choose to use anti-VEGF therapy you need to educate yourself, educate the families and parents of the children you treat, perform an appropriate informed consent, and make sure you have the ability to follow these patients frequently and long term.