AIM: To evaluate the influence of age and axial length (AL) on the position of the fovea in patients with high myopia (HM). METHODS: In this prospective study, 96 patients (186 eyes) with HM were consecutively recruited from the Third Affiliated Hospital of Nanchang University. DRI-OCT Atlantis, fundus imaging, and IOL Master were used in this study. Three indices were measured: the distance between the fovea and the optic nerve head (ONH) center (DFO), the vertical distance between the fovea and the horizontal line pass of the ONH center (VDFO), and the horizontal distance between the fovea and the vertical line pass of the ONH center (HDFO). These measurements were used to analyze the effects of different age groups (A1, A2, A3 groups) and AL (AL1, AL2, AL3, AL4 groups) on these indices. RESULTS: The results showed that there was no statistical significance in DFO among the age and AL groups (F=0.46, 0.37; P=0.62, 0.76, respectively). In HDFO, there was also no statistical significance among the age and AL groups (F=0.10, 0.48; P=0.90, 0.69, respectively). In VDFO, however, the difference in the age and AL groups was statistically significant (F=3.21, 3.12; P=0.04, 0.02, respectively). Thus, VDFO were correlated with age and AL (r=0.21, 0.23, all P<0.01), while HDFO and DFO were not correlated with age and AL (r=0.30, P>0.05). CONCLUSION: In high myopia, the foveal position changes mainly in the vertical direction along with factors of age and AL.