To evaluate the choroidal thickness by high-penetration optical coherence tomography (OCT) using long wavelength in highly myopic normal-tension glaucoma (NTG). Cross-sectional retrospective study. Institutional. Twelve eyes from 8 patients under 45 years old, diagnosed as NTG without any other ocular diseases, spherical equivalent refractive error between -6 and -12 diopters, and axial length greater than 26.5 mm; and 12 eyes of matched healthy volunteers. Choroid was imaged with prototype high-penetration OCT and its thickness was measured. Choroidal thickness at the fovea and 5 locations: 2 mm superior, temporal, and inferior to the center of the optic nerve head, and 2 mm superior (superotemporal) and 2 mm inferior (inferotemporal) to the temporal location. Overall, the choroidal thickness in the NTG group was approximately 50% that in controls. Mean choroidal thickness in the NTG group was significantly thinner in the control group at the fovea (166 vs 276 μm, P < .001), superior (172 vs 241 μm, P < 0.05), superotemporal (161 vs 244 μm, P < .01), temporal (110 vs 161 μm, P < .01), and inferotemporal (115 vs 159 μm, P < .05) to the optic nerve head. Stepwise analysis disclosed that the foveal choroidal thickness is the most influential factor on the occurrence of NTG (P < .0001, R(2) = 0.4). Choroidal thickness in highly myopic NTG is significantly thinner than in controls, at least in some specific locations. Choroidal thinning is somehow related with highly myopic NTG and may be a useful diagnostic parameter for myopic NTG. Copyright © 2012 Elsevier Inc. All rights reserved.