High myopia, defined as a refractive error greater than –6.00 diopters or an axial length exceeding 26.5 mm, is increasingly recognized as a major cause of visual impairment worldwide. The excessive elongation of the eyeball predisposes affected individuals to a spectrum of structural changes and secondary complications that threaten vision. Progressive scleral thinning and posterior staphyloma lead to stretching of the retina, choroid, and sclera, which in turn increases the risk of myopic maculopathy, lacquer cracks, and choroidal neovascularization. Degenerative changes in the retina and choroid are the leading causes of irreversible vision loss in pathological myopia, particularly in elderly populations. In addition, high myopia is strongly associated with rhegmatogenous retinal detachment, which occurs due to peripheral retinal thinning, lattice degeneration, and vitreoretinal traction. Other common complications include early-onset cataract, open-angle glaucoma, and vitreous degeneration. Advances in multimodal imaging, such as optical coherence tomography (OCT) and fundus autofluorescence, have improved the diagnosis and monitoring of these complications, allowing earlier intervention. Current management strategies range from pharmacologic approaches, such as anti-VEGF therapy for myopic choroidal neovascularization, to surgical interventions including vitrectomy and scleral reinforcement. Despite these advances, prevention of myopia progression during childhood remains the most effective strategy for reducing long-term complications. Public health initiatives focusing on lifestyle modification, early detection, and regular ophthalmic monitoring are essential in mitigating the burden of high myopia–related blindness. Continued research is necessary to refine therapeutic strategies and improve visual outcomes in this growing patient population.