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Purpose To determine the incidence of full-thickness macular holes in Olmsted County, Minnesota. Design Population-based retrospective chart review (cross-sectional study). Participants Ninety-four eyes of 85 patients who were residents of Olmsted County, Minnesota. Methods A population-based retrospective chart review was performed for all diagnoses of macular hole between 1992 and 2002 among residents of Olmsted County, Minnesota. Yearly incidence rates for each given age and sex group were determined by dividing the number of cases within that group by the estimated total Olmsted County resident population of the group for that given year. Main Outcome Measures Documented clinical diagnosis of a macular hole. Results Idiopathic macular holes occur at an age- and sex-adjusted incidence in 7.8 persons and 8.69 eyes per 100,000 population per year in Olmsted County, Minnesota. The female-to-male ratio was determined to be 3.3 to 1, and bilateral idiopathic macular holes occurred in 11.7% of patients and accounted for 20.9% of the affected eyes. Conclusions This study uniquely determined the incidence of macular holes in a predominantly Caucasian population. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.