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—I thank Dr Gass for helping to clarify the three important biomicroscopic criteria essential for diagnosing impending macular hole formation and also for stressing the difficulty in making the diagnosis in the initially involved eyes.I agree that eyes with separation of the vitreous from the foveal retina are at very low risk of hole formation. Those eyes were included in the study to demonstrate that, indeed, they are at low risk of developing a macular hole. The definition of impending macular hole that I used in this article is the one commonly used by vitreoretinal surgeons. (My own definition agrees with that of Gass.) My hope was to convince vitreoretinal surgeons of the importance of the vitreous examination and to point out that a significant number of so-called impending holes do well without surgery.To my knowledge, the important points that Dr Gass makes have not been
Trempe CL. Risk of Developing Macular Hole-Reply. Arch Ophthalmol. 1991;109(5):611-612. doi:10.1001/archopht.1991.01080050016004