Retinopathy of prematurity (ROP) is a major cause of blindness in children in middle-income countries. In 1995, it accounted for 10.6% of blindness in children in schools for the blind in South Africa. This study was undertaken to estimate the number of premature babies at risk and to investigate policies, practices and screening programmes. 13000 to 15000 surviving premature babies are at risk of ROP each year. Shortage of equipment precluded continuous oxygen monitoring in public units. Nursing levels were often below recommendations, and most nurses were unaware of target oxygen saturations. Private units were well staffed and adequately equipped. Ophthalmologists were only visiting four units on a regular basis for screening, using the birth weight criterion of ,1500 g for ROP screening. ROP needing treatment rates were low (1.6–2.9%), as were rates of follow-up. Access to neonatal care is increasingly available and babies are being saved at all levels. Unless concomitant strategies are put into place for screening, Retinopathy of prematurity is likely to be a major cause of blindness.