Review of Retinopathy of Prematurity Management in the Anti-VEGF Era: Evolving Global Paradigms, Persistent Challenges and Our AI-Assisted Future.

Retinopathy of prematurity (ROP) remains a major cause of preventable blindness in premature infants worldwide, with increasing incidence due to advancements in neonatal care. Management of ROP has been revolutionised by anti-vascular endothelial growth factor (anti-VEGF) treatments. Pivotal clinical trials have demonstrated the efficacy of anti-VEGF in the management of Type 1 ROP, while investigation of safety and long-term effects is ongoing. However, infants with ROP often have persistent avascular retina (PAR) despite treatment and require lifelong monitoring for myopia, glaucoma, amblyopia, strabismus, significant refractive error, retinal tears and detachment and adult reactivation of ROP. Alternative therapeutics, including beta-blockers, polyunsaturated fatty acids and vitamin A, remain under investigation. Alongside therapeutic advancements, artificial intelligence (AI) and telemedicine programmes have the potential to expand screening accessibility, particularly in underserved regions, and improve inter-observer variability, though challenges in implementation remain. Together, advanced therapeutics and AI-enhanced screening hold promise for improving outcomes and reducing ROP-related blindness globally.