Retinopathy of prematurity (ROP) is a leading, largely preventable cause of childhood blindness in preterm infants, arising from disturbed retinal vascular development and multiple perinatal risk factors. The purpose of this narrative review is to synthesize current evidence on ROP epidemiology, pathophysiology, and modifiable risks, and to outline recent advances in diagnosis and management. We summarize the evolution from laser photocoagulation to intravitreal anti-vascular endothelial growth factor (VEGF) therapy, discussing benefits, limitations, and safety concerns, including persistent avascular retina and late reactivation. Emerging strategies such as dual VEGF/angiopoietin-2 blockade, insulin-like growth factor-1–targeted interventions and ultra-low-dose anti-VEGF regimens are briefly reviewed. We also highlight evolving screening paradigms – including wide-field imaging, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, teleophthalmology, and artificial-intelligence-supported tools – that may enable more individualized, risk-adapted ROP care and help reduce avoidable blindness worldwide.