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Importance: Identifying peripheral retinal lesions in high myopia patients before implantable collamer lens (ICL) surgery by nonmydriatic Optomap ultrawide field imaging. Background: To investigate specificity and sensitivity of nonmydriatic Optomap ultrawide field imaging for detecting peripheral retinal lesions in high myopia patients before ICL surgery. Design: Hospital-based, cross-sectional study. Participants: A total of 1725 high myopic eyes of 897 ICL surgery candidates were included in this study. Methods: Patients with high myopia were scheduled for routine ophthalmic examination before ICL implantation. Nonmydriatic Optomap ultrawide field imaging was applied for detecting potential peripheral retinal lesions before ICL surgery. Main Outcome Measures: Presence of peripheral retinal lesions. Results: Of 1725 eyes, 344 (19.94%) had peripheral retinal lesions in total; 75 (4.35%) eyes had holes/tears; 313 (18.14%) eyes had peripheral retinal degenerations. Sensitivity of Optomap for detecting peripheral retinal holes/tears and degenerations were 57.33% (95% confidence interval [CI]: 45.38-68.69) and 65.18% (95% CI: 59.61-70.45). Specificity for peripheral retinal holes/tears and degenerations were 99.58% (95% CI: 99.13-99.83) and 99.08% (95% CI: 98.43-99.51), respectively. A total of 22.70% (32/141) of omitted peripheral retinal lesions under Optomap needed intervention. Longer axial length (odds ratio [OR]: 1.16, P < .01), more severe refractive error (OR: 1.05, P < .01) and older age (OR: 1.03, P < .01) were proved to be risk factors for peripheral retinal degenerations in high myopes. Conclusions and Relevance: Optomap ultrawide field imaging is a reliable adjunctive tool with high specificity and moderate sensitivity for identifying and recording peripheral retinal lesions in high myopes in preoperative Danjuan Yang and Meiyan Li contributed equally as first authors.