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Objective Currently, retinopathy of prematurity (ROP) screening requires a full retinal examination. To reduce the screening burden, we assessed whether a single optic nerve-centred image could detect treatment-requiring ROP. The objective is to investigate the use of a single image centred around the optic disc to detect treatment-requiring ROP, to reduce the burden of ROP screening with the same security of a full retinal examination.Design Retrospective case series.Setting Tertiary referral centre.Population Premature infants screened for ROP in a tertiary referral centre.Main outcome Vascular dilation and tortuosity on a scale from 1 to 5 were blindly labelled by three independent ROP experts using a 8 by 8 mm optic nerve-centred images. Images were automatically generated from images of the routine screening examinations.Results A total of 278 patients (556 eyes) with a mean gestational age of 28.4±2.0 weeks and a mean birth weight of 1059.7±324.0 g were included. Treatment was needed in 49 eyes (8.8%) of 25 patients. A total of 1510 image sets centred on the optic disc were obtained and analysed. When the cut-off of the vascular dilatation and tortuosity rating was fixed at 3 (equivalent to a severe preplus disease), sensitivity and specificity for the detection of prethreshold type 1 ROP were 100% and 88.9%, respectively.Conclusions ROP screening using a single posterior pole image could reduce stress in premature infants without degrading the quality of screening, compare to iterative dilated complete fundus examination.