PROJECT SUMMARY Advances in neonatal care have led to increased survival of even the tiniest infants who have been born before term (9 months). Prematurity has long term consequences for health, vision and retinal function. Retinopathy of prematurity (ROP) is an active disease in early infancy and, in view of the improved neonatal care, puts an increasing number of infants in jeopardy of lifelong eye problems including poor vision and refractive errors such as high myopia. It has been estimated that the number of “blind years” for which a preterm infant is destined may equal that encountered by adults with some of the most common eye problems. A team of experienced investigators with complementary expertise present a proposal for non-invasive studies in children with a history of prematurity, with or without ROP, to fill gaps in knowledge about vision, retinal function, and refractive error. The studies, organized into four Specific Aims, are designed to test hypotheses about ROP rod photoreceptor signals to post receptor retinal neurons (Aim 1), the structure to function relationships in the central retina that includes the fovea and mediates some of the most important visual functions (Aim 2); and the role of retinal and choroidal parameters as determinants of eye size and refractive error (Aim 3). These experiments follow a cross-sectional design with subjects (aged 10 to 20 years) stratified by ROP severity (Aims 1 and 2) or grouped by myopia or emmetropia (Aim 3). A longitudinal study (Aim 4) of infants with a history of severe posterior ROP will compare visual, refractive and retinal development in those treated using an intra-vitreal anti-VEGF agent to those treated using laser ablation of the peripheral retina. The long term objectives are to achieve new understanding of the ROP disease process and its aftermath including visual impairment and high refractive error, particularly high myopia.