Laser photocoagulation is a time-tested, well-defined, and effective treatment for retinopathy of prematurity (ROP) with requirements for follow-up that are much more manageable compared with anti-vascular endothelial growth factor (anti-VEGF) therapy, argued David K. Wallace, MD, MPH.
Read the other side of the debate: Treating ROP: Substantial benefits make anti-VEGF preferred for Zone I disease
Dr. Wallace outlined the reasons why a physician might choose laser over anti-VEGF injections for treating ROP.
“There are situations where anti-VEGF injections may be better than laser treatment, such as in eyes with Zone I disease,” said Dr. Wallace, professor of ophthalmology and pediatrics, Duke University, Durham, NC. “In addition, we might use both treatments in eyes with Zone I disease, adding laser after anti-VEGF therapy if vascularization stalls and worrisome signs develop. However, there are cases where laser may be a better choice, and there is still a lot we need to know about anti-VEGF therapy for ROP.”
Presenting a “top-10 list” of reasons to consider laser for ROP rather than anti-VEGF therapy, Dr. Wallace said the absence of systemic side effects with laser versus the yet-to-be-defined systemic safety of anti-VEGF therapy represents the most compelling argument.
“We know that anti-VEGF drugs enter the blood and that serum VEGF levels are reduced after intravitreal anti-VEGF injection,” Dr. Wallace explained. “We don’t know how reductions in circulating VEGF affect developing organs that rely on VEGF, but a recent study analyzing data from the Canadian registry of premature infants found significantly worse motor development in preterm babies treated with bevacizumab (Avastin, Genentech) compared with those treated with laser [Pediatrics. 2016 Apr;137(4)].”