It’s not enough to know a lamellar macular hole (LMH) when you see one. What you see could also be a similar-looking but different clinical entity altogether. The same goes for epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). Now that OCT is becoming more commonplace in research and hospitals, researchers are hoping to better define these three presentations using their appearance on OCT as a basis.

The updated definitions of the presentations are based primarily on their anatomical features. The LMH definition includes three mandatory criteria: the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. The definition also includes three optional features: the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone.

The new ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle’s fiber layer. It can also include three optional anatomical features: microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and retinal wrinkling.

MPH’s definition includes three mandatory criteria: foveal-sparing ERM, a steepened foveal profile and an increased central retinal thickness. As with LMH, MPH has optional anatomical features: microcystoid spaces in the INL and a normal retinal thickness.

The hope is that these updated definitions will help guide future research and offer hints at more targeted therapies.