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Improving Follow-up of Infants during Retinopathy of Prematurity Screening in Rural Areas. OBJECTIVE: To evaluate the challenges of completing and improving follow-up in an retinopathy of prematurity (ROP) screening program in rural centers. METHODS: Reasons for dropout from a multi-center ROP screening program in rural Karnataka, over two six-month periods, were collected and categorized. Improvement measures introduced between the two periods and its impact was analyzed. RESULTS: Reasons pertaining to travel and logistics (15 of 53, 28.3%) and those related to awareness, knowledge and attitude (30 of 53, 56.6%) were the two main categories of reasons for dropout. Following corrective measures, there was a reduction in attrition from 20.8% to 3.8% (P <0.001). Pediatricians' role in ensuring follow-up remained an important persisting reason. CONCLUSION: Customizing improvement measures addressing the challenges of rural geographical logistics and enhancing awareness among rural families can enhance participation and improve follow-up.