Purpose: To examine the features of myopia-related optical coherence tomography (OCT) findings in a population-based setting. Design: Population-based study. Participants: The Beijing Eye Study 2011 included 3468 subjects with an age of 50 years or more. Methods: The participants underwent a detailed ophthalmic examination including OCT with enhanced depth imaging of the macula. Main Outcome Measures: Optical coherence tomography features of the macula in highly myopic eyes defined by a refractive error of -6 diopters or less or an axial length of 26.5 mm or more. Results: Readable OCT images were available for 6530 eyes (94.5%) of 3278 participants. The most common change in the macula was maculoschisis (0.8 +/- 0.1%), followed by incomplete posterior vitreous detachment (0.7 +/- 0.1%), disruption of the photoreceptor inner segment/ outer segment interface (0.6 +/- 0.1%), epiretinal membranes (0.6 +/- 0.1%), macular defects in Bruch's membrane (0.3 +/- 0.1%), clumping of the retinal pigment epithelium (0.2 +/- 0.1%), vitreofoveal adhesion (0.2 +/- 0.1%), and macular holes in 2 eyes (0.1 +/- 0.1%). Prevalence of any myopic maculopathy per eye was 112 of 6530, or 1.71 +/- 0.16% (95% confidence interval [ CI], 1.40e2.03). After adjustment for longer axial length (P< 0.001; odds ratio [ OR], 2.68; 95% CI, 1.97e3.64) and myopic refractive error (P< 0.001; OR, 0.63; 95% CI, 0.55e0.73), presence of any myopic maculopathy was not significantly associated with any systemic variables (all P < 0.05), including biochemical blood examination and ocular parameters. Best-corrected visual acuity was associated significantly with the absence of a disruption of the photoreceptor inner segment/outer segment interface (P< 0.001), epiretinal membranes (P< 0.001), and macular holes (P< 0.001) after adjustment for age and cylindrical refractive error. Conclusions: Based on OCT examination, the most common macular change in highly myopic eyes was maculoschisis, followed by incomplete posterior vitreous detachment, disruption of the photoreceptor inner segment/ outer segment interface, epiretinal membranes, macular defects in Bruch's membrane, clumping of the retinal pigment epithelium, vitreofoveal adhesion, and macular holes. The most important macular changes with a negative effect on best-corrected visual acuity were a disruption of the photoreceptor inner segment/outer segment interface and epiretinal membranes. Ophthalmology 2014; 121: 220-224 (C) 2014 by the American Academy of Ophthalmology.