Purpose: The purpose of this study was to describe the academic performance of childhood retinoblastoma (RB) survivors. Design: Retrospective cohort study. Methods: Retrospective chart review of children followed in a survivorship clinic. Results: A total of 73 patients with RB (median age at diagnosis: 9.97 months; range: 0.29-65.1) were followed for a median of 6.4 years (0.2-1.76). A total of 48 patients (65.8%) had unilateral RB; 43 patients (63.0%) received systemic chemotherapy; and 57 patients (78.1%) underwent enucleation. At last follow-up, 5 children (6.8%) had bilateral visual acuity (VA) <20/70. Seventeen subjects (23.3%) reported school difficulties, and 10 subjects (13.7%) had an individualized education program (IEP). Multivariate analysis revealed that a history of receiving chemotherapy” Multivariate analysis revealed that a history of receiving chemotherapy was associated with self-reported school difficulties (odds ratio [CI]: 5.44; 95% confidence interval [CI]: 1.36-21.69; P =.016), and undergoing an IEP (OR: 11.47; 95% CI: 1.34-98.16; P =.03). The degree of visual impairment and history of enucleation did not influence the risk of self-reported school difficulties or the implementation of an IEP. Among unilateral RB patients, chemotherapy was an independent risk factor for self-reported school difficulties (OR: 12.8; 95% CI: 1.45-113; P =.009) and implementation of an IEP (OR: 15.2; 95% CI: 0.78-292; P =.02). Conclusions: Academic difficulties in childhood RB survivors are associated with chemotherapy treatment, a risk factor independent of VA.