This study aimed to establish the prevalence of retinopathy of prematurity (ROP) among high-risk neonates in a tertiary centre, identify the most commonly associated risk factors and highlight the benefits of early treatment of type 2 ROP and ROP milder than type 1 with pre-plus disease. This was a retrospective cross-sectional study of 307 high risk infants (614 eyes) with gestational age of ≤32 weeks and birth weight of ≤1500g from 2011-16. Prevalence of ROP was 33.71%; 55 infants needed treatment of ROP. ROP milder than type 1 with pre-plus disease was in 84 treated eyes (40.58%); group 1. Type 2 ROP was in 13 treated eyes (6.28%); group 2. High risk type 1 ROP was in 12 treated eyes (6.80%); group 3. Treatment was with photocoagulation. After treatment, eyes were stable in two, nine and zero eyes (groups 1-3 respectively). Eleven, 74 and 10 eyes had regressed ROP; none, one and two eyes progressed. Mechanical ventilation, hypoxemia, hypercarbia and intracranial haemorrhage were significantly associated with ROP development along with history of neonatal intensive care unit (NICU) admission, neonatal sepsis, surfactant replacement treatment with necrotising enterocolitis. The authors recommend strict adherence to international screening guidelines with thorough retinal examination of all preterm neonates, especially those with high risk. Parental education regarding the importance of follow-up compliance is necessary.