To analyze the natural evolution of idiopathic lamellar macular holes (LMH) and macular pseudoholes (MPH) in the long term, based on optical coherence tomography (OCT) configuration and on best corrected visual acuity (BCVA) evolution. A prospective, longitudinal study. We prospectively analyzed 108 eyes (67 left eyes and 41 right eyes) of 99 patients (55 female and 44 male) whose eyes had been diagnosed as having an MPH or an LMH on OCT examination. The following variables were assessed: BCVA; lens status; and hole size (diameter, residual foveal thickness, and perifoveal thickness) at baseline and at final examination. The mean follow-up period was 31.07 ± 18.77 (12 to 84) months. The mean BCVA (logMAR) in the total group at baseline was 0.31 ± 0.25, and at final examination it was 0.22 ± 0.21 (p = 0.200). Moreover, we did not observe statistically significant differences regarding diameter, residual foveal thickness, or perifoveal thickness (p = 0.325). Most idiopathic LMH and MPH do not progress anatomically and do not contribute to a significant diminution in visual acuity during the follow-up period. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.