Background <p>Ultra-wide field imaging (UWFI) is an invaluable tool for screening, documentation, and follow-up of retinal pathology. However, despite widespread use, the optimal image acquisition strategy and accuracy for detecting potentially-treatable peripheral retinal breaks is not fully known. We report our data from Dublin, Ireland.</p> Methods <p>A retrospective analysis was carried out on all consecutive patients undergoing treatment of peripheral retinal breaks in the Royal Victoria Eye and Ear Hospital from March 2022 to August 2024. Patients with pre-operative UWFI using Optos California equipment were included. Data were analysed on UWFI accuracy by break type and location, media opacity, lens status, refractive error and compared to gold-standard clinical indented exam.</p> Results <p>A total of 336 peripheral retinal breaks requiring treatment in 275 eyes of 238 patients were included. UWFI detected 83% of breaks, increasing to 96.9% with peripheral steered imaging. Sensitivity was significantly greater for temporal and nasal breaks compared to those superiorly and inferiorly (<i>p</i> &lt; 0.00001) and for breaks posterior to or at the equator compared to those anterior to it (<i>p</i> &lt; 0.00001). The detection of superior, inferior and anterior breaks was significantly increased with peripheral steered imaging (<i>p</i> &lt; 0.00001). Sensitivity was not affected by vitreous haemorrhage (<i>p</i> = 0.57), refractive error (emmetropia/myopia/high myopia, <i>p</i> = 0.16) or lens status (phakic/pseudophakic, <i>p</i> = 0.06)</p> Conclusion <p>We report the largest study on real-world clinical utility of UWFI for treatment-requiring peripheral retinal breaks to date. With proper use and peripheral image acquisition, UWFI is a powerful screening tool and adjunct to clinical examination, but does not obviate careful, dilated clinical exam.</p>