The purpose of this study was to investigate the clinical course of patients with idiopathic vitreomacular adhesion (VMA) with a noncomparative case series of patients who had clinical symptoms and spectral-domain optical coherence tomography findings consistent with VMA. The VMA was graded based on the optical coherence tomography findings at initial and follow-up examinations. Grade 1 was incomplete cortical vitreous separation with attachment at the fovea, Grade 2 was the Grade 1 findings and any intraretinal cysts or clefts, and Grade 3 was the Grade 2 findings and the presence of subretinal fluid. Results: 106 eyes of 81 patients were identified as having VMA by spectral-domain optical coherence tomography with mean age at 73 years and the mean time of follow-up was 23 months. Forty-three eyes (41%) had Grade 1 VMA, 56 eyes (52%) had Grade 2 VMA, and seven eyes (7%) had Grade 3 VMA. By the last follow-up, spontaneous release of VMA occurred in 34 eyes (32%), and pars plana vitrectomy was performed in five eyes (4.7%). Mean best corrected visual acuity was 0.269 logarithm of the minimum angle of resolution or 20/37 at baseline (range, 20/20–20/200) and logarithm of the minimum angle of resolution 0.251 or 20/35 at the last examination (range, 20/20–20/400). The study concluded that in this selected patient cohort with mild symptoms, the clinical course of patients with VMA managed by initial observation was generally favourable.