Retinopathy of prematurity (ROP) is identified clinically by a pattern of incomplete and abnormal retinal vessel development in preterm infants. Assessment is centered on determining whether retinal findings indicate a course of disease that requires treatment. Optical coherence tomography (OCT) imaging reveals features in ROP that are difficult to identify with use of any other examination and imaging modalities. Although imaging is typically limited to posterior zones, the retinal view, the three-dimensional (3D) view, and cross-sectional B-scans provide unique perspectives of the developing retinal structures and vasculature, the location of the fovea, the vascular-avascular junction, extraretinal neovascularization, intraretinal cystoid spaces, subretinal fluid, traction, and schisis. These can be monitored at the bedside over time and after treatment.