Purpose: To quantify changes in visual function parameters and the macular neuroretina of patients with Fibromyalgia (FM) over 5 years, compared with controls. Methods: Eighty patients with FM and 38 healthy subjects were included in a prospective observational study and underwent visual acuity (VA) evaluation with ETDRS chart, contrast sensitivity vision (CSV) with CSV 1000E test, and retinal evaluation using Spectralis Optical coherence tomography (OCT). All subjects were re-evaluated after 5 years to quantify changes in visual function parameters and ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness. The relationship between progressive structural, functional and disease severity changes was analysed. Additionally, patients were classified into three different groups to analyse progression depending on the disease phenotype. Results: When compared with controls, patients with FM presented worse low contrast VA (p=0.024), and low frequency CSV (p=0.004) after a 5-year follow up. A progressive decrease affecting the GCL thickness (nasal 1, p=0.004; temporal 1, p<0.001; inferior 1, p=0.001) and the RNFL (nasal 1 and 2, p<0.001; superior 1, p<0.001; and inferior 1, p=0.002) was observed in patients over the monitoring time. Changes affecting the GCL were correlated with progression in disease severity scores (EQ-5D, r=0.560, p<0.001; FIQ, r=-0.470, p=0.003). Correlations between structural changes and disease severity scores were only observed in the atypical and biologic phenotypes. Conclusions: Progressive visual dysfunction and retinal neurodegeneration was detected in FM patients. The evaluation of visual parameters and GCL/RNFL thickness using SD-OCT can be useful to monitor FM progression.