Background/Aims: Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. The BOOST II, SUPPORT and COT trials recommended increasing O2 saturation targets for pre-term neonates to reduce mortality; however, this is a risk factor for ROP. We aimed to determine whether these targets increased prevalence of ROP among pre-term neonates and higher risk groups. Methods: Retrospective cohort study conducted using data from the Australian and New Zealand Neonatal Network. 17 298 neonate cohort born 2012–2018 at <32 weeks' GA and/or <1500 g BW was analysed. Adjusted odds ratios (aORs) were calculated for post-2015 risk of: any ROP; ROP ≥ Stage 2; and treated ROP. Sub-analysis stratified at <28 GA, < 26 weeks' GA, <1500 g BW and <1000 g BW was performed. Results: Risk of any ROP increased in the post-2015 group (aOR = 1.23, 95% confidence interval (CI) = 1.14–1.32), <28 weeks' GA (aOR = 1.31, 95% CI = 1.17–1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28–1.91), <1500 g (aOR = 1.24, 95% CI = 1.14–1.34) and <1000 g (aOR = 1.34, 95% CI = 1.20–1.50). ROP ≥ Stage 2 increased at <28 weeks (aOR = 1.30, 95% CI = 1.16–1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28–1.91), <1500 g (aOR = 1.18, 95% CI = 1.08–1.30), and <1000 g (aOR = 1.26, 95% CI = 1.13–1.42). Conclusion: O2 therapy guidelines since 2015 have resulted in decreased mortality but increased risk of ROP. Individualised NICU adjustments of ROP screening/follow-up methods are necessary to address the clinical burden.