Macular degeneration can result in legal blindness among those with progressive myopia and posterior staphyloma. Programmed photoreceptor death, apoptosis, is operative in some. Electrophysiologic and psychophysiologic techniques can permit detection of functional abnormalities before lesions become clinically apparent. Macular choroidal neovascularization occurs more often in those with moderate staphyloma than in those with advanced atrophy in the posterior pole. Indocyanine green angiography is improving our understanding of this complication, which has been correlated with an increased number of posterior choroidal drainage systems. One study suggests that surgical extirpation of the neovascular network may be beneficial in some, but the role of scleroplasty procedures in prevention remains uncertain. Experimental myopia modeling continues apace, but specific molecular pathways and their genomic control are yet to be elucidated. Clinically, clear lens extraction and biphakia techniques are under investigation to offer refractive relief to the severely myopic patients who are not candidates for current keratorefractive methods.