Background: In myopic anisometropia, investigation of alterations in the retinal capillary network may reveal the myopic pathophysiology and facilitate development of improved treatment and prevention strategies. This study aimed to evaluate alterations in retinal vessel density in patients with myopic anisometropia using optical coherence tomography angiography. Methods: Twenty-one patients with myopic anisometropia were divided into longer axial eye and contralateral eye groups, based on their axial length measurement by an IOL Master system. Automated macular and peripapillary maps and vessel density calculations were evaluated using optical coherence tomography angiography, and the findings were compared between groups. Results: The longer axial eye group had higher superficial macular vessel density (47.06±3.03% vs. 43.71±3.20%, respectively; P <0.001) and lower radial peripapillary capillary density (50.11±3.56% vs. 52.34±2.74%, respectively; P =0.013) than did the contralateral eye group. The spherical equivalent negatively correlated with the superficial macular vessel density ( P =0.021) and superficial parafoveal vessel density ( P =0.014). No significant differences were detected in the deep macular vessel density (49.12±6.32% vs. 46.73±5.30%, respectively; P >0.05), choriocapillary perfusion area (1.92±0.18 mm 2 vs.1.90±0.19 mm 2 , respectively; P >0.05), or foveal avascular zone area (0.27±0.07 mm 2 vs. 0.28±0.07 mm 2 , respectively; P >0.05) between groups. Conclusion: The superficial macular vessel density and radial peripapillary capillary density could be used as indicators to monitor myopic anisometropia development during early-stage retinopathy.