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<b>Background:</b> In twin births, both babies have the same gestational age and pre-natal conditions. However, twins may develop a varied retinopathy of prematurity (ROP) course depending on birth weight and other systemic factors. <b> Objective:</b> To study the profile of asymmetric ROP in twins <b> Design:</b> Retrospective study <b> Setting:</b> Tertiary ROP referral eye hospital. <b> Materials and Methods:</b> The profile of 56 pairs of twins with ROP were studied and analyzed for differences in zone or need for treatment, while studying possible causes for the varied outcome. <b> Results:</b> In 45 pairs of twins (80&#x0025;) the disease progressed identically in both eyes, while in 11 pairs (20&#x0025;) the ROP showed differences in zone or need for treatment. Four of these pairs were discordant. In 3 of these 4 pairs, the heavier birth weight twin had a more severe ROP course. <b> Conclusions:</b> Twins can present with asymmetric ROP course, and it is therefore essential to examine both twins as per screening protocols.