In the first of the "Great Debates in Pediatric Ophthalmology" at AAO 2023, Drs. Michael Blair and C. Armitage Harper III discuss the case of a 24-week-old premature boy with a corrected gestation age of 36 weeks who presents with Zone I, Stage 3 with Plus retinopathy of prematurity (ROP) in both eyes. The debate focuses on which initial anti-VEGF medication to use, next steps if there is reactivation of ROP within 4 to 6 weeks, and what would need to be done with the peripheral vascular retina if there is no reactivation.