Purpose To describe the coincidence of perforating scleral vessels and choroidal neovascularization (CNV) in pathologic myopia. Methods Medical records and multimodal imaging were reviewed from patients with CNV secondary to pathologic myopia who presented to the Medical Retina and Imaging Unit of San Raffaele Hospital in Milan between October 2015 and March 2016. Main outcomes were the prevalence of coincident perforating scleral vessels and overlying CNV and association between perforating scleral vessels and CNV position within the macula and neovascular activity. Results Forty-one eyes of 39 patients (6 male, 33 female, mean age 63.7 ± 14.1 years) with CNV secondary to pathologic myopia were included in the study. Scleral perforating vessels (average number of perforating vessels per eye 2.1 ± 1.0) were found in 29 out of 41 eyes (70.7%) at the site of CNV. There was no association between presence of perforating vessels and neovascular activity or CNV position. Conclusions Perforating scleral vessels are often coincident with myopic CNV. We hypothesize that scleral vessels located beneath myopic CNV can play a role in neovascular development.