BACKGROUND AND OBJECTIVE: To assess the safety and effectiveness of transpupillary thermotherapy treatment of subfoveal choroidal neovascular membrane secondary to pathologic myopia. PATIENTS AND METHODS: Seventy-four patients (74 eyes) with pathologic myopia underwent transpupillary thermotherapy treatment using a 3.0-mm spot size, 1-minute duration, and 520-mW power delivered through a contact lens. Clinical evaluation included measurement of best-corrected Snellen visual acuity, slit-lamp biomicroscopy, fundus color photography, and fluorescein angiography. RESULTS: Sixty-four eyes (86%) received one treatment session. Six eyes (8%) improved 0.1 logarithm of the minimum angle of resolution (LogMAR) visual acuity post-treatment, 10 eyes (13.5%) lost more than 0.2 LogMAR acuity, and another 10 eyes (13.5%) lost 0.1 LogMAR acuity. The remaining 48 eyes (65%) had unchanged visual acuity after the last follow-up visit. CONCLUSION: Transpupillary thermotherapy preserves vision in patients with choroidal neovascular membrane associated with pathologic myopia. Younger patients and eyes with higher refractive error are more likely to benefit from treatment. [Ophthalmic Surg Lasers Imaging 2010;41:12–17.]