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This analysis of all ROP screening and treatment episodes from 2019 (one year prior to the COVID-19 pandemic) to 2023 (three years post-pandemic) evaluates trends in the annual number of screenings and treatments, change in prematurity profile and proportion of cases diagnosed with ROP and requiring treatment.The pandemic reduced ROP screening activity by 22.7% (p = 0.02). The number of treatments dropped by nearly half during the lockdown. Trend analysis in the post-pandemic period revealed a rebound, with both screenings—including outpatient screenings—and treatments increasing compared to the pre-pandemic period. Between 2019 and 2023, the overall number of screening and treatment episodes rose by 22.4% (p = 0.08) and 164.3% (p = 0.03), respectively. The increase in treatments was statistically highly significant.Between 2019 and 2023 the proportion of patients diagnosed with ROP increased from 22.8% to 33.3% and the percentage of patients with ROP requiring treatment rose from 30.3% to 64.1%. The proportion of extremely preterm infants requiring screening rose from 31.0% in 2019 to 45.3% in 2023.The pandemic temporarily reversed the growing number of ROP screenings and treatments and improved the prematurity profile. However, now levels are worse than pre-pandemic. The increasing numbers of extremely preterm infants may explain the increasing frequency of treatment requiring ROP.This analysis suggests we should explore why case numbers reduced during the pandemic, why they are now increasing and what can be done to improve service delivery to tackle the increasing numbers of cases today.