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Optical coherence tomography (OCT) is a noninvasive imaging test. OCT imaging is analogous to ultrasound imaging, except that it uses light instead of sound. In this type of image, microscopic quality intratissue images are provided. In addition, fast and direct imaging of tissue morphology and reproducibility of results are the advantages of this imaging. Macular holes are a common eye disease that leads to visual impairment. The macular perforation is a rupture in the central part of the retina that, if left untreated, can lead to vision loss. A novel method for detecting macular holes using OCT images based on multilevel thresholding and derivation is proposed in this paper. This is a multistep method, which consists of segmentation, feature extraction, and feature selection. A combination of thresholding and derivation is used to diagnose the macular hole. After feature extraction, the features with useful information are selected and finally the output image of the macular hole is obtained. An open-access data set of 200 images with the size of 224 × 224 pixels from Sankara Nethralaya (SN) Eye Hospital, Chennai, India, is used in the experiments. Experimental results show better-diagnosing results than some recent diagnosing methods. [ABSTRACT FROM AUTHOR]