For the time being, risk of ROP seems inexorably linked to survival of extremely low birth weight prematures, whose embryonic retinas develop in an abnormal and fluctuating environment. Incidence and severity may be reduced by stabilizing ventilation, oxygenation, and perfusion, moderating light exposure, and providing normal levels of vitamin E. Progression of stage 3 retinopathy may sometimes be arrested by cryotherapy. In the future, antioxidants or other pharmacologic agents may be developed to provide a greater margin of safety. In the meantime, the eyes of prematures must be examined and those with ROP will need specialized ophthalmologic care.