PURPOSE: To investigate the prevalence, features, and risk factors of macular retinoschisis (MRS) in highly myopic eyes and their morphological features in a Chinese population. DESIGN: Population-based, cross-sectional study. From the Beijing Eye Study 2011, a total of 213 highly myopic eyes from 129 participants were included. METHODS: All participants underwent spectral-domain optical coherence tomography with a macula cube scan of 30 degrees x30 degrees centered in the fovea. High myopia was defined as a refractive error <=-6 diopters or an axial length >= 26.0 mm. MRS presence and its subtypes were assessed based on location, and affected retinal layers were evaluated. Prevalence, features, and associated factors of MRS and its subtypes in highly myopic population were assessed. RESULTS: Of 213 highly myopic eyes (129 participants), MRS was observed in 48 eyes, with a prevalence of 22.5% (95% CI, 16.9-28.6) per eye, or 36 participants with 27.9% (95% CI, 20.5-35.7) per subject. In addition to well-documented factors such as older age and higher myopia, the prevalence of MRS was found to be related with a higher intraocular pressure (P = .013, odds ratio [OR], 1.25; 95% CI, 1.05-1.48), a thinner subfoveal choroidal thickness (P = .006, OR, 0.86; 95% CI, 0.77-0.96), a wider Gamma zone (P = .003, OR, 1.99; 95% CI, 1.05-3.11), the presence of glaucoma (P = .010, OR, 3.37; 95% CI, 1.34-8.48), and the presence of epiretinal membrane (P = .023, OR, 3.13; 95% CI, 1.17-8.36) after multivariate analysis. Eyes with advanced high myopia (P = .021) and wider gamma zone (P = .005) were more likely to develop foveal MRS. Eyes with glaucoma tended to have a higher prevalence of outer retinal MRS compared with inner retinal MRS (60.9% vs 36.0%), although the difference was not statistically significant (P = .06). MRS located in the foveal region or affecting the outer retina was related with a significantly worse best-corrected visual acuity (BCVA) compared with MRS that was perifoveally located or affected other regions (P < .05). CONCLUSIONS: The prevalence of MRS was 27.9% among the elderly highly myopic population. MRS occurring in the foveal region or involving the outer retina demands increased vigilance due to its significant impact on BCVA. The findings contribute to a deeper understanding of MRS, offering insights into its mechanisms and vision prognosis. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/))