We monitored 132 patients (148 eyes) with idiopathic, full-thickness macular holes for a mean of 52 months. Ninety-six of the patients were women and 61 were in their 60s. The initial sizes of the macular holes correlated highly with initial visual acuity (P less than .0001). Although most macular holes enlarged during the study, long-term visual acuity was stable. Although these patients had a significantly (P less than .05) higher prevalence of cardiovascular disease, the incidences of hysterectomies and estrogen supplements were not unusually high. Seventy-one patients had some type of pigment epithelial disease (P less than .05).