Retinopathy of prematurity (ROP), a well-known complication of preterm birth that can result in avoidable blindness and visual impairment, is especially sensitive to the quality of neonatal inpatient care and appropriate, well-monitored oxygen. In 2010, the annual incidence of blindness and visual impairment from ROP was estimated to be 32,200 cases worldwide. The greatest burden is seen in middle-income countries, particularly where coverage of neonatal inpatient care has expanded without due attention to the quality of care provided, and the neonatal nursing skills and training of those providing this care. India accounted for nearly 10% of all estimated worldwide visual impairment following ROP in 2010, with at least 5,000 developing severe disease and 2,900 children surviving with visual impairment related to ROP. Screening all those at risk and providing treatment for those with severe disease will require investment to increase the capacities and competencies of eye-care providers. Scale-up of neonatal services must be coupled with implementation of standards for high quality care, including safe oxygen management, and detection and treatment of ROP. Otherwise the number of children surviving preterm birth with visual impairment secondary to ROP will continue to increase in India and worldwide.