Numerous studies have indicated that high myopiais associated with a higher risk for glaucomatous optic neuropathy. However, structural and functional changes induced by glaucoma can be confounded by high myopia because the latter itself can cause a series of retinal and nerve fiber layer damage. In order to find glaucomatous changes in high myopia and reduce the potential of missed diagnosis or misdiagnosis, a deep understanding of clinical features of high myopia with glaucoma was needed. This artical summarizes the functional roles and potential difficulties of classical stuctural and functional investigations in diagnosis of high myopia with glaucoma. This review is also introduced some possible solutions to navigate this diagnostic dilemma.