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Background: To evaluate the efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening. Design: Retrospective study in a quaternary public neonatal intensive care unit. Participants: A total of 108 premature infants screened for retinopathy of prematurity. Methods: Retrospective chart and photo review were performed on participants screened by both serial wide-field digital retinal imaging and concurrent binocular indirect ophthalmoscopy. Review of captured digital photos was performed independently by a masked reader. Using the binocular indirect ophthalmoscopy findings as the gold standard, the efficacy of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prematurity, defined as type 1 prethreshold disease, was determined. Main Outcome Measures: Sensitivity and specificity of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prematurity. Results: Treatment-requiring retinopathy of prematurity was detected in 11 infants by both binocular indirect ophthalmoscopy examination and telemedicine images taken at the same visit. Wide-field digital retinal imaging has a sensitivity of 100% (95% CI: 76.2–100%) and a specificity of 97.9% (95% CI: 93.4–99.7%) in detecting infants with treatment-requiring retinopathy of prematurity. Positive and negative predictive values of wide-field digital retinal imaging were 84.6% (95% CI: 57.8–97.3%) and 100% (95% CI: 96.9–100%), respectively. Conclusions: Wide-field digital retinal imaging is accurate, reliable and efficient in detecting treatment-requiring retinopathy of prematurity. Incorporating wide-field digital retinal imaging with telemedicine in standard retinopathy of prematurity management can potentially improve delivery, accessibility, quality and cost of retinopathy of prematurity care.