Abstract Purpose The purpose of this study was to determine the relationship between macular sensitivity (MS) and posterior staphyloma (PS) in highly myopic eyes. Methods This cross‐sectional, observational study included 646 highly myopic eyes (spherical equivalent (SE) ≤−5.00D and the international meta‐analysis for pathologic myopia classification grade of <2) from 362 participants. MS was measured using microperimetry and evaluated between eyes with and without PS. Correlations between MS and PS were determined in multivariate regression models. Results Although there was no significant difference in best‐corrected visual acuity (BCVA) ( p = 0.07), the MS of the PS group was significantly lower than the no PS group at the central 2°, 4°, 6°, 8° and 10° (all p < 0.001). After controlling age, axial length (AL) and SE, the MS in the PS group was still lower than the no PS group from 2° to 10° (all p < 0.05). In a multivariable analysis adjusting for age, AL, SE and BCVA, the presence of PS was significantly associated with lower MS in the central 2°–10° (all p < 0.05). Conclusions Lower MS was independently associated with the presence of PS in highly myopic eyes. Even when BCVA was not significantly different, MS still could reveal subtle changes in visual function in highly myopic eyes with PS.