This review article describes the pathophysiology of retinopathy of prematurity (ROP). The authors start by introducing the condition and its incidence. There is extensive information on the pathophysiology mechanisms involved in the condition to include normal and pathological retinal development. The first and second phases of ROP are described and the role of growth factors is discussed. There is a section for the genetic component of ROP and discussion on recent study findings to understand the factors that contribute to its aetiology and management. The article provides a good overview of the condition to include evidence from recent studies.