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To compare the long-term visual outcomes of intravitreal bevacizumab (IVB) with those of photodynamic therapy (PDT) for myopic choroidal neovascularization over a 7-year period.Eyes treated with IVB (17 eyes) or PDT (20 eyes) that were followed up for at least 7 years were included in this retrospective study. Myopic maculopathy was classified according to the international photographic classification before treatment. The best-corrected visual acuity (BCVA) and the chorioretinal atrophy (CRA) size were measured before and after treatment over a 7-year period.The mean change in BCVA at 7 years was greater in the IVB group than in the PDT group (P = 0.044). While BCVA improved from baseline throughout the 7-year period in the IVB group (P = 0.029), there was no improvement in the PDT group (P = 0.266). In subgroup analysis for 18 eyes with preoperative tessellated fundi (Category 1), there was no difference in BCVA improvement (P = 0.166) and CRA size between the 2 groups at 7 years. However, for 17 eyes with preoperative diffuse CRA (Category 2), BCVA remained unchanged in the IVB group and decreased in the PDT group (P = 0.030) at 7 years.IVB resulted in superior long-term functional and anatomical outcomes compared with PDT. In particular, PDT resulted in a greater BCVA decrease and CRA increase compared with IVB in eyes with preoperative diffuse CRA. However, the clinical outcomes were not different in eyes with preoperative tessellated fundi.