Purpose: To highlight the use of multimodal imaging for detecting and monitoring macular neovascularization (MNV) in the presence of focal choroidal excavation. Methods: A case and its findings were analyzed. Results: Spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were performed in a 30-year-old Asian woman with metamorphopsia in the left eye. Imaging showed striking MNV secondary to focal choroidal excavation, and an impressive response to antivascular endothelial growth factor therapy was seen throughout the follow-up. Conclusions: OCTA is a noninvasive, useful imaging modality for diagnosing and monitoring patients with MNV secondary to focal choroidal excavation.