Eyes with tears of detached retinal pigment epithelium have been studied for up to 10 years following the acute event. In a retrospective study it has been determined that such a lesion in one eye implies a high risk of a similar event occurring in the fellow eye. Patients with loss of vision in their second eye as a result of a pigment epithelial tear were also studied; in 10 of 22 patients a similar lesion could be identified in the first eye. These observations suggest that these patients have specific changes at the level of Bruch's membrane which predispose to this particular manifestation of age related macular disease.