With the rapid development of aerospace and nuclear energy technologies, there is an urgent need for optical fibers with excellent anti-radiation properties. Specialized optical fibers are crucial for applications in space communication and sensing, space measurement and acquisition, and satellite-to-ground communication However, radiation in extreme environments can damage fibers, reduce their transmission capacity, and compromise their stability and safety. This paper reviews the relevant literature on improving the anti-radiation performance of optical fibers and presents the current status of efforts to improve the anti-radiation performance of these fibers. Existing methods include altering the core or cladding materials and implementing various pre-treatments. By comparing the mechanisms and influence of these approaches, it is evident that combining multiple methods can remarkably improve the anti-radiation performance of transmission optical fibers. Specifically, combining pre-irradiation, H₂ and D₂ loading, annealing, photobleaching, and appropriate doping elements substantially improves the fiber anti-radiation performance. These findings offer a reliable approach for deploying optical fibers in extreme environments, and their successful implementation paves the way for future optical fiber research and applications, where more innovative and efficient methods can be explored to continually enhance optical fiber reliability and stability under extreme conditions.