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BACKGROUND AND OBJECTIVE: To investigate the effect of age and refractive error on changes in the retinal microvascular network. PATIENTS AND METHODS: Subjects were recruited from the Doheny Eye Institute. Refractive error and axial length were measured. High myopia was defined as refractive error greater than −6 diopters (D). Optical coherence tomography angiography (OCTA) imaging was performed and images were analyzed using fractal analysis. Primary outcomes were superficial capillary plexus (SCP) vessel density, deep capillary plexus (DCP) vessel density, and foveal avascular zone (FAZ) area. RESULTS: One hundred thirty-eight eyes of 69 subjects were included. Twenty-eight (41%) subjects were male and 41 (59%) subjects were female. Mean age was 42.81 years ± 19.91 years (range: 8 years to 87 years). Mean refractive error was −1.74 D ± 3.18 D (range: −15.78 D to 4.25 D), and mean axial length (AL) was 24.29 mm ± 1.35 mm (range: 21.73 mm to 28.32 mm). SCP and DCP vessel densities were negatively correlated to age (r = −0.22, P = .011; and r = −0.49, P < .001). Controlling for age, patients with high myopia and longer AL had decreased SCP density ( P = .021 and P = .027, respectively), but no difference in DCP vessel density was observed ( P = .065 and P = .058, respectively). FAZ area was not significantly correlated to age, gender, refraction, or AL. CONCLUSIONS: SCP and DCP vessel densities decreased with age. In addition, SCP density but not DCP vessel density was reduced in eyes with high myopia and longer AL. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:925–931.]