With the rapid development of modern medicine, there are several approaches for correcting refractive errors in high myopia. However, refractive progression after correction still continues. On the other hand, the management of fundus pathology in high myopia often fails to reverse or control the progression of the disease. Despite application of some advanced treatments, fundus pathology has become the main cause of blindness in these patients. Refractive progression is the result of scleral expansion and axial elongation and fundus pathology is a reaction of the choroid and retina to posterior scleral expansion. Therefore, intervention should be aimed at scleral expansion. There is no doubt about the rationality of controlling scleral expansion with posterior scleral reinforcement (PSR). However, this approach was restricted by the status of medicine and technology in the past because surgical techniques and materials could not meet the essential requirements for the surgery to have a real effect. As a result, PSR failed to gain wide clinical recognition. In recent years, as surgical techniques and materials have improved, the efficacy of PSR to stabilize axial length progression and treat macular retinoschisis, macular hole and macular detachment were further confirmed. Full attention should be paid to controll the progression of high myopia and fully understand the clinical value of PSR. The clinical indications of PSR should be to control and treat fundus pathology in high myopia. With gradual improvement and standardization of the surgical procedures and materials, the clinical results of PSR will continue to improve, and PSR is expected to become a key option for preventing blindness in high myopia.