The purpose of this Japanese study was to analyse the morphologic features and natural progression patterns of lacquer cracks (LC). The presence of linear hyperfluorescence on the fundus fluorescein angiography (FFA) was used as the standard for diagnosing the presence of LCs. Medical records of 47 highly myopic eyes with LCs were examined. Lacquer cracks were observed bilaterally in 14 patients and unilaterally in the other 19 patients. The background maculopathy level was C1 (tessellated fundus) in nine eyes (19.1%), C2 (diffuse atrophy) in 22 eyes (46.8%), and C3 (patchy atrophy) in 16 eyes (34.0%) based on the META-PM classification. Myopic choroidal neovascularisation (CNV) was found in 10 eyes (21.3%), simple haemorrhages in 17 eyes (36.2%), myopic traction maculopathy in three eyes (6.4%), and P (LCs) in 13 eyes (27.7%). Among the 36 eyes that had multiple LCs at the initial examination, the LCs of 10 eyes had a branching pattern, and the LCs were separated from the others in the other 26 eyes. None of the eyes had a stellate pattern; 44.3% of the LCs were located temporal to the fovea. The orientation of the LCs was horizontal in 40 (22.7%), vertical in 38 (21.6%), and oblique in 98 (55.7%). A total of 41 eyes of 28 patients had a follow-up of >1 year. The most common progression pattern was an increase in the number of LCs in 18 of 41 eyes. A progression to patchy atrophy occurred in 6 of 41 eyes (14.6%).