This study aimed to describe a process of identifying birth weight and gestational age screening guidelines in Mongolia using telemedicine for retinopathy of prematurity (ROP) screening. This was a single centre prospective study collecting data from December 2016 to January 2017. Of 196 infants, three were excluded because of missing data, leaving 329 examinations of 193 infants. Mean birth weight was 1427g and mean gestational age (GA) was 30 weeks. There were 49.7% male. Eighteen infants (9%) had birth weight and GA outside USA screening guidelines of which eight had type I ROP (seven treated with anti-VEGF and one with anti-VEGF and vitrectomy). Seventy-five (38.9%) developed ROP of any stage; 44 (22.8%) of type 2 or worse. Four (2.07%) progressed to stage 4 but none to stage 5. A total of 38 had treatment (laser, anti-VEGF and / or vitrectomy). Birth weight and GA distributions were similar to others reported in low and middle income countries. The results have contributed to evidence-based screening guidelines that were subsequently implemented in Mongolia. The relative risk of developing ROP in infants born at ≤29 weeks was 2.92 and for birth weight of ≤1200g, was 2.41. Telemedicine was used successfully in this study.