Risk of Developing Macular Hole

To the Editor. —In their recent article in theArchives, Akiba and coworkers1report their follow-up results of 45 patients (45 eyes) with early-stage idiopathic macular hole. The termearly-stage macular holeimplies a lesion with the potential for hole formation. However, their findings, as well as the findings of Trempe et al2and myself,3suggest that eyes with separation of the vitreous from the foveal retina are at no risk of hole formation. Therefore, their present study is actually a follow-up of 27 eyes, not 45, since 18 eyes had separation of the vitreous from the fovea and were at no risk of hole formation at the time of entry into the study. See also pp 635 and 654. The criteria of Akiba et al1for early-stage macular hole included biomicroscopic findings of "a focal, mild deviation of the inner retinal surface instead of foveal depression, but no retinal