M yopia is a major worldwide public health issue, particularly in the Asia-Pacific region. 1-3 The prevalence of myopia has exponentially increased in the past decades and is now recognized by the World Health Organization as a leading cause of visual impairment. 4 High myopia is of grave concern because it is associated with sight-threatening ocular comorbidities like myopic maculopathy, glaucoma, and retinal detachment.High myopia is generally defined as a refractive error of ≤ −6 D (spherical equivalent) in the context of axial length ≥ 26.5 mm. 5,6 Holden et al 5 estimated that 163 million people (2.7% of the world population) had high myopia in the year 2000 and was predicted to rise to 938 million (9.8% of the world population) by 2050. The development of myopia involves the progressive and excessive axial elongation of the globe. Pathologic myopia may occur in highly myopic eyes with characteristic degenerative changes in the posterior segment, which can result in irreversible vision loss. The cardinal features of pathologic myopia include posterior staphyloma 7 and myopic maculopathy. To date, literature provides detailed definitions of the characteristic macular lesions in myopic maculopathy based on the findings of fundus examination and optical coherence tomography (OCT). 8,9 Currently, pathologic alterations of the optic nerve and optic neuropathy related to high myopia are recognized yet ill-elaborated in myopia research. Earlier studies have reported a 28.5% of prevalence of glaucomatous optic neuropathy (GON) in high myopia. Indeed, high myopia eyes were 5.9 times more likely to develop GON than emmetropic eyes. 10 Nevertheless, structural abnormalities in the optic nerve head (ONH) with corresponding perimetric defects have also been demonstrated in pathologic myopia with myopic maculopathy. 11 Therefore, it would be of interest to clinicians to understand the underlying structural abnormalities of the optic nerve in high myopia and to differentiate the optic neuropathy that arises due to high myopia from glaucoma.In this issue of the Asia-Pacific Journal of Ophthalmology, Jiang et al 11 conducted a cross-sectional study by secondary analysis of data from a longitudinal cohort which included 1389 eyes of 857 highly myopic patients without pathologic myopic maculopathy to determine the prevalence and characteristics of ONH structural abnormalities on OCT and their relationship with visual field (VF) defects.The authors reviewed swept-source OCT scans and classified 12 distinct ONH abnormalities based on 3 categories: optic disc morphology, papillary/peripapillary tissue defects, and papillary/peripapillary schisis. Their investigation revealed over 90% of eyes showed at least 1 ONH abnormality, and nearly 35% had 3 or more, with up to 27.3% demonstrating correspondence in the locations of VF defects were present. The most prevalent VF defect in nonpathologic high myopia was the enlargement of a blind spot on perimetry. This is the first study to demonstrate the presence of ONH structural abnormalit...