Short Axial Length Increases Likelihood of Fellow-eye Idiopathic Macular Hole

A prospective study found that among patients with unilateral idiopathic macular hole, those who experienced fellow-eye occurrence over a five-year period had a significantly shorter mean axial length than patients who didn’t develop macular hole in their other eye (21.42mm vs. 22.98mm). These images from the study show baseline images of the right (A) and left (B) eyes and images at the same follow-up time point showing new macular hole development in the right (C) eye and postoperative status of the left (D) eye. Photo: Cho Y, et al. J Ophthalmol. April 10, 2026. Click image to enlarge. Previous research has shown that patients with unilateral macular hole have a shorter axial length, prompting speculation that individuals with this risk factor may also be more likely to develop the condition in the fellow eye. This hypothesis was recently confirmed through a prospective five-year follow-up study recently published in Journal of Ophthalmology.The study followed 100 unilateral idiopathic macular hole patients and age- and sex-matched controls. The researchers prospectively observed the incidence of macular hole in the fellow eye over a five-year period, then compared the mean axial length between fellow eyes that developed new macular holes vs. those that did not. Throughout follow-up, a total of 11 fellow eyes in unilateral macular hole patients developed a new macular hole, while no cases were reported in the control group. Fellow eyes with new macular hole had a significantly shorter mean axial length than fellow eyes without new macular hole (21.42mm vs. 22.98mm).Given these findings, the researchers wrote in their paper that “because axial length is routinely measured and easily obtainable in clinical practice, it may serve as a practical parameter for identifying high-risk patients and guiding follow-up intervals.” Additionally, they suggested, “Regular OCT surveillance should be considered for patients with short axial length in the fellow eye.”Since only idiopathic macular holes were evaluated in this study, the authors point out that “future study into macular holes caused by other mechanisms is needed,” such as high myopic macular holes and those that occur after vitrectomy.Click here for the journal source. Cho Y, Byun H, Yoo W-S, Chung I. Axial length as a risk factor for idiopathic macular hole: a five-year prospective study. J Ophthalmol. April 10, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.