Natural history of macular holes in the era of optical coherence tomography

Watzke and Allen3 devised a test to examine for macular holes. Thinking now about this ingenious test, it had used the principles of Optical coherence tomography (OCT) even before OCT was ever known. Their test utilized the distortion caused displacement of photoreceptors along the perimeter of the whole and later lack of junction of those photoreceptors. By shining a line of light mostly vertically over the macular hole, a small waist or dehiscence can appear in the line of light. In the pre era, Gass4 devised a grading system for macular holes based on biomicroscopic findings. This system is still widely used in clinics and literature. It is also useful in predicting the visual outcome of surgical interference for macular holes. In the OCT era, new findings can be deducted from scanning the retina. With the availability of OCT to almost all major eye units at least; in western countries, OCT features of macular holes can be used in conjunction to the original Gass grading system. We are now aware of the term Occult PVD which means that posterior hyaloid is detached from the fovea but still attached to the optic disc.