With modern surgical techniques to repair retinal detachments, a greater than 90% primary anatomic success rate can be expected. Despite this high level of anatomic success, visual results remain compromised mainly because of permanent functional damage once the macula becomes detached. The most important predictor of visual recovery after retinal detachment surgery is preoperative visual acuity. Preoperative acuity appears to be directly related to the height of macular detachment. Shorter duration of detachment and younger age are also important in visual recovery. This paper will review the current literature that helps to improve our understanding of visual recovery after macula-off retinal detachments.