Myopic traction maculopathy (MTM) is a vision-threatening condition associated with high myopia, posing public health concerns due to the global rise in the prevalence of myopia. MTM encompasses various pathological changes, including foveoschisis, macular hole formation, and retinal detachment, which can lead to irreversible vision loss if not detected or managed early. Understanding choroidal perfusion, particularly in highly myopic eyes, is crucial because the choroid undergoes changes such as thinning and reduced perfusion, which may influence the onset and severity of myopic maculopathy. This chapter explores the importance of choroidal perfusion in MTM and its role in guiding surgical interventions. This chapter investigates two key hypotheses: the impact of various surgical approaches on the postoperative choroidal vascularity index (CVI) and the correlation between the CVI and postoperative visual outcomes following current surgical techniques. This chapter discusses the advantages and limitations of CVI, future research directions, and potential therapeutic implications.