Meta-analysis of ROP treatments finds anti-VEGF linked to less myopia than laser or surgery

BackgroundRetinopathy of prematurity (ROP) survivors commonly develop myopia, yet refractive sequelae may differ substantially by treatment. We compared long term refractive outcomes after anti-VEGF, laser photocoagulation, cryotherapy, and vitrectomy.MethodsA systematic review was performed using PubMed, Embase, Web of Science, and the Cochrane Library from inception to July 2025. We also screened records from a curated EndNote library. The primary outcomes were mean spherical equivalent (SE) and the prevalence of high myopia (SE ≤ −5.0 D). Pooled estimates were calculated using a DerSimonian and Laird random effects model. Prespecified subgroup analyses compared treatment zone (Zone I vs. Zone II or III) and monotherapy vs. combination therapy.ResultsEighty-six studies, including 10,269 eyes were analyzed. Anti-VEGF had the least myopic pooled mean SE (−1.9 D) compared with laser (−3.8 D), cryotherapy (−5.8 D), and vitrectomy (−6.3 D). High myopia prevalence was 21.3% after anti-VEGF versus 42.6% after laser, and 55.4% to 58.6% after vitrectomy or cryotherapy. Compared with laser, anti-VEGF reduced the risk of high myopia (RR = 0.39; 95% CI: 0.25–0.61). Heterogeneity was moderate to high (I2 = 52%–78%), and Egger’s tests were not significant (p = 0.21 for SE; p = 0.37 for high myopia).ConclusionAmong major ROP treatments, anti-VEGF was associated with the most favorable refractive outcomes, while cryotherapy and vitrectomy showed the highest myopic burden. These findings support incorporating long term refractive consequences and zone-specific risk into treatment selection and follow up planning.