The optic nerve head in highly myopic eyes is distinctly different from normal optic disks. We performed magnification-corrected morphometry of photographs of 51 optic nerve heads in highly myopic eyes (myopic refraction of more than -8.00 diopters). Mean refraction was -15.49 +/- 5.76 diopters (range, -8.00 to 28.00 diopters), mean age 63.0 +/- 12.1 years (range, 27-87 years). The disks were significantly (P less than 0.000001; Wilcoxon-Mann-Whitney test) larger and more ovally configurated than 457 unselected normal optic nerve heads with a myopic refraction of less than -8.00 diopters. Refraction, size of the disk, and area of the parapapillary region with chorioretinal atrophy were significantly (P less than 0.00001) correlated with each other. The parapapillary vessel diameter was independent from the disk size. Highly myopic disks can be regarded as secondary acquired macrodisks, the size of which is correlated with refraction and possibly age. They should be differentiated from secondary, acquired macrodisks in congenital glaucoma and from primary macrodisks. As in normal eyes, the parapapillary vessel caliber can be used to estimate the optic disk size in relative and approximately absolute units.