Myopia above -6.00D is generally referred to as high myopia, which is also known as pathological myopia because of the pathological changes in the fundus of the eye. High myopia is one of the most common diseases that seriously affects vision. The anterior and posterior axis of the eye increases in length, and there is progressive chorioretinal degeneration in the posterior pole. There are often tilted optic nerve papillae, myopic arcs and leopard-like fundus, which can be combined with lacquer cracks, limited subretinal hemorrhages, Fuchs’ spots (RPE proliferation), posterior staphyloma, RPE and choroidal atrophy, and choroidal neovascularization. Posterior staphyloma: The posterior part of the highly myopic eye grows significantly and forms a limited scleral dilatation in the posterior pole, which is called posterior staphyloma. The onset is closely related to the axial length of the eye and choroidal retinal atrophy. When the lesion involves the macula, it often results in a loss of central vision. Patients with posterior staphyloma are prone to macular fissure, macular fissure retinal detachment, and macular clefting. RPE and choroidal atrophy: Localized atrophy may appear as a round or irregular shaped yellow-white area with delimited borders and pigment aggregation. Extensive atrophy can be seen as a yellowish-white area in the entire posterior pole of the eye, which is the exposed sclera. During the progression of myopia, the atrophic spots tend to fuse. Lacrimation and subretinal hemorrhage: Lacrimation is the most typical lesion of Bruch’s membrane in highly myopic eyes, manifesting as very fine linear or star-shaped, irregularly thick and thin yellow-white streaks. Lacrimation is generally considered to be a rupture of the Bruch’s membrane, which can be complicated by subretinal hemorrhage in the macula. Patients often have sudden vision loss and visual distortion in their youth, and their vision may improve after the hemorrhage is absorbed. However, the hemorrhage may recur in the same area later. Most highly myopic eyes with macular hemorrhage are associated with lacquer cracks. Fuchs’ spot and choroidal neovascular membrane: Any dark spot in the posterior pole of highly myopic eyes can be called Fuchs’ spot, which is caused by the proliferation of RPE cells. Typically, it is located in or near the macula and is a slightly elevated, gray or black, round or oval patch about 1/3 to 3/4 of the diameter of the optic papilla. Macular hemorrhage and Fuchs’ spots may represent different processes of choroidal neovascularization. Choroidal neovascularization can occur in up to 40.7% of highly myopic eyes. When choroidal neovascularization grows inward, acute painless vision loss and visual distortion may occur. Peripheral retinal degeneration and retinal detachment: About 1/3 of highly myopic eyes have some peripheral retinal degeneration, including lattice degeneration, snowball deposits and atrophic retinal fissures. 1/4 have non-specific changes, such as “non-pressure whitening”, frost-like degeneration and irregular pigmentation. In the peripheral retinal degeneration area, it is easy to cause retinal fissure formation in the atrophic area, and some retinal detachment occurs. Retinal detachment is significantly higher in highly myopic than in normal people. The higher the degree of myopia, the more likely it is to occur. Retinal detachment can be devastating to the affected eye, so all patients with high myopia should have their fundus checked at least once a year by a fundopath. Vitreous degeneration: Vitreous degeneration is often present in highly myopic eyes, often at an early age, and becomes more pronounced with age. The vitreous humor decondenses and liquefies, forming a cloudy substance that floats in the vitreous cavity. It moves with the position of the eye, and patients are often disturbed by mosquito hallucinations. Posterior vitreous detachment may occur later. Funduscopic examination reveals a grayish ring in the vitreous in front of the optic nerve papilla, which drifts with the eye movement. This vitreous opacity should be distinguished from acute retinal fissure formation. Acute retinal fissure formation is often caused by vitreous traction, due to a small amount of hemorrhage, and the patient can see flashes of light in front of the eyes as well as a larger number of small black dots floating around.