OBJECTIVE To assess the changing spectrum of ROP, and to compare the siblings of multiple gestations with regard to incidence and severity of ROP. METHODS A prospective study was done among a total of 158 infants (including 19 twin pairs), selected for ROP screening as per American Academy of Pediatrics (AAP) criteria. Data collected was analysed to assess the changing ROP spectrum in comparison to year 2002 ROP screening data from the authors' centre, and the variations among siblings of multiple gestation. RESULTS Overall incidence of ROP was about 45.57% in 2009 as compared to 44.60% in 2002. 17 risk factors were found significantly associated with ROP on univariate analysis with low gestational age, low birth weight and multiple gestation (not analyzed in the 2002 data) confirmed as independent risk factors for ROP .The absolute number of subjects with severe ROP (>stage III) has decreased at the authors' centre. Twins with ROP were sicker as compared to the other sibling. CONCLUSIONS Though overall incidence of ROP has remained the same over the last decade at the authors' centre, absolute number of severe forms of ROP has decreased. Multiple gestations may be taken as an independent risk factor for ROP causation. Sicker the twin infant is, the more are the chances that he/she will develop ROP.