Background: Much remains unknown about the influence of severity of prematurity and presence of retinopathy of prematurity (ROP) on the development of the fovea after preterm birth during the perinatal period from postmenstrual age (PMA) 30 to 44 weeks. Aims: Measures of foveal morphology, individual retinal layers and foveal oedema (CME), with and without ROP using HH-OCT, adjusting for gestational age (GA) and birthweight (BW). Methods: Prospective mixed cross-sectional and longitudinal study of infants (23 to 36 weeks GA). Foveal width, area, depth, central foveal thickness (CFT), individual retinal layers and CME severity were analysed. Infants with ROP were included until they underwent treatment. Results: HH SD-OCT images (n=344) from n= 112 infants were suitable for analysis (n=278 foveal morphology, retinal layers; n=66 CME). A significant interaction between ROP and PMA independent of GA or BW (p < 0.001), was due to increasing foveal width with PMA for ROP and decreasing in the non-ROP group. This correlated with significantly increased outer retinal layers in early PMA (p < 0.001). Severity of GA and BW correlated with foveal area (p < 0.005) and depth (p≤0.001); CFT (p=0.007) correlated only with GA. In the perinatal period, the thicker fovea observed 3 in early GA compared to later born infants is due to an increased INL (p=0.005). CME was present in 22% of all infants. CME severity may relate to presence or absence of the external limiting membrane (ELM). Conclusions: Dynamic differences exist between foveal parameters and retinal layers during the perinatal period depending on the severity of prematurity and presence of ROP. Independent of GA and BW, foveal width has potential as a marker that distinguishes between infants with and without ROP in early screening using HH SD-OCT. The severity of CME may relate to ELM disruption; further study would aid understanding of any adverse future outcomes.