Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UHR OCT provides addi tional information on disease morphology, pathogenesis, and management; and to u se UHR OCT as a baseline for improving the interpretation of the standard reso lution images. Design Observational and interventional case series. Participants Twenty nine eyes of 24 patients clinically diagnosed with macular hole in at l east one eye. Methods A UHR OCT system has been developed and employed in a ter tiary care ophthalmology clinic. Using a femtosecond laser as the lowcoherence light source, this new UHR OCT system can achieve an unprecedented 3 μm axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR OCT and standard 10 μm resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the populati on before and after macular hole surgery. Main outcome measures Ultrahigh and s tandard reso lution cross sectional OCT images of macular hole pathologies. R esults Both UHR OCT and standard resolution OCT exhibited comparable performan ce in differentiating various stages of macular holes. The UHR OCT provided imp roved imaging of finer intraretinal structures, such as the external limiting me mbrane and photoreceptor inner segment (IS) and outer segment (OS), and identifi cation of the anatomy of successful surgical repair. The improved resolution of UHR OCT enabled imaging of previously unidentified changes in photoreceptor mor phology associated with macular hole pathology and postoperative repair. Visuali zation of the junction between the photoreceptor IS and OS was found to be an im portant indicator of photoreceptor integrity for both standard resolution and U HR OCT images. Conclusions Ultrahigh resolution optical coherence tomography i mproves the visualization of the macular hole architectural morphology. The incr eased resolution of UHR OCT enables the visualization of photoreceptor morpholo gy associated with macular holes. This promises to lead to a better understandin g of the pathogenesis of macular holes, the causes of visual loss secondary to m acular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh resolu tion optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR OCT images. Comparisons of UHR OCT images with standard resolution OCT images can establish a baseline for the better in terpretation of clinical standard resolution OCT images. The ability to visuali ze photoreceptors and their integrity or impairment is an indicator of macular h ole progression and surgical outcome. Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UHR OCT provide addi tional information on disease morphology, pathogenesis, and management; and to u se UHR OCT as a baseline for improving the interpretation of the standard reso lution images. Design Observational and interventional case series. Participants Twenty nine eyes of 24 patients clinically diagnosed with macular hole in at l east one eye. Methods A UHR OCT system has been developed and employed in a tiary care ophthalmology clinic. Using a femtosecond laser as the lowcoherence light source, this new UHR OCT system can achieve an unprecedented 3 μm axial resolution for retinal OCT imaging. standard 10 μm resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also perfor med on a subset of the populati on before and after macular hole surgery. Main outcome measures Ultrahigh and s tandard reso lution cross sectional OCT images of macular hole pathologies. R esults Both UHR OCT and standard resolution OCT showing comparable performan ce in differentiating various stages of the macular holes. The UHR OCT provided imp roved imaging of finer intraretinal structures, such as the external limiting membrane and photoreceptor inner segment (IS) and outer segment (OS), and identification of the anatomy of successful surgical repair. resolution of UHR OCT enabled imaging of previously unidentified changes in photoreceptor mor phology associated with macular hole pathology and postoperative repair. Visuali zation of the junction between the photoreceptor IS and OS was found to be an im portant indicator of photoreceptor integrity for both standard resolution and U HR OCT images. Conclusions Ultrahigh resolution optical coherence tomography i mproves thThe visualization of the macular hole architectural morphology. The incr eased resolution of UHR OCT enables the visualization of photoreceptor morpholo gy associated with macular holes. This promises to lead to a better understandin g of the pathogenesis of macular holes, the causes of visual loss secondary to m acular holes, the timing of surgical repair, and the evaluation of postsurgical outcomes. Ultrahigh resolu tion optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR OCT images. Comparisons of UHR OCT images with standard resolution OCT images can establish a baseline for the better in terpretation of clinical standard resolution OCT images. The ability to visualize ze photoreceptors and their integrity or impairment is an indicator of macular h ole progression and surgical outcome.