In 14 of 27 eyes with choroidal neovascular membranes associated with severe myopia, visual acuity deteriorated two or more lines on the Snellen chart. Twelve of the 27 eyes became legally blind. Final visual acuity may be related to the position of the neovascular membrane within the posterior pole. Four of the eight eyes with new vessels outside of the foveal avascular zone had follow-up visual acuities of 6/12 (20/40) or better. Only one of five eyes with new vessels extending to the edge of the avascular zone had a final visual acuity of 6/12 (20/40) or better. Three of 14 eyes with a neovascular membrane beneath the foveal avascular zone had visual acuities of 6/12 (20/40) or better. Neovascularization associated with severe myopia clearly jeopardizes central visual acuity. Laser photocoagulation therapy may be useful in treating neovascular membranes outside the foveal avascular zone or extending to the edge of the perifoveal capillary network. A larger prospective study is needed to determine the guidelines for and efficacy of such treatment for patients with severe myopia who develop choroidal neovascularization.