The study examined morphological changes in peripapillary atrophy (tissue changes around the optic nerve) in 172 patients (316 eyes) with high myopia using optical coherence tomography. Patients were divided into groups according to the axial length of the eye: PM1 (≥30 mm), PM2 (≥28 and <30 mm), PM3 (<28 mm) and simple high myopia. The results showed that with increasing eye length and progressive deterioration, patients' age, axial length, and intraocular pressure increased, while visual acuity and spherical equivalent decreased. The four key zones of peripapillary atrophy (PPA1-4) along with scleral flange curvature angle (SCA) and scleral flange curvature angle (SFCA) showed a general increase. Analysis demonstrated that PPA1 and SCA were strongly correlated with visual acuity, axial eye length, and spherical equivalent. The authors concluded that the modified zones of peripapillary atrophy identified by OCT imaging, especially PPA1 and SCA, are important indicators for assessing the state of high myopia.