Background/objectives <p>Although severe retinopathy of prematurity is known to be associated with adverse refractive outcomes, the refractive impact of mild or regressed disease in more mature preterm infants remains unclear. To determine whether retinopathy of prematurity (ROP), even in mild or regressed forms, is associated with altered refractive development in mid-preterm infants during early childhood.</p> Subjects/methods <p>This retrospective cohort study included 231 infants categorised as mid-preterm infants with ROP, mid-preterm infants without ROP, late preterm infants with and without ROP, and term controls. Cycloplegic refraction was assessed after 60 weeks postmenstrual age using handheld autorefraction and confirmed by retinoscopy. Spherical error and spherical equivalent (SE) were compared between groups.</p> Results <p>Significant differences in spherical error and spherical equivalent were observed across the study groups (<i>p</i> = 0.007 and <i>p</i> = 0.002, respectively). Among mid-preterm infants, those with a history of ROP demonstrated a significantly greater myopic refractive profile compared to those without ROP (sphere: <i>p</i> = 0.028; SE: <i>p</i> = 0.012). No significant refractive differences were observed between late preterm infants with and without ROP. No cases of high myopia were identified.</p> Conclusions <p>ROP is associated with a greater myopic refractive tendency specifically in mid-preterm infants. These findings suggest that the coexistence of prematurity and ROP may influence early refractive development even in the absence of severe disease or treatment. Mid-preterm infants with regressed ROP may represent an underrecognised risk group that could benefit from targeted refractive surveillance during early childhood.</p>