Retinal pigment epithelial tears are a major complication of pigment epithelial detachment (PED) in the elderly. We observed the pretear process of PED in 38 patients (40 eyes) to identify characteristic angiographic changes. Before the tear occurred, the filling pattern of the PED underwent alterations, including an increase in the size and a modification in the shape of the PED (27 eyes); the development of notches (14 eyes); and the onset or increase of subretinal fluid, hard exudates, and/or hemorrhages (30 eyes). The most noteworthy feature was the uneven filling of the PED, with a remarkably hypofluorescent central area that remained dark until the late angiographic frames (24 eyes). Conversely, hyperfluorescence appeared early at the margins of the PED, increased progressively, and sometimes demonstrated a crenated edge. The high risk of tearing indicates that laser treatment of the retina should be considered carefully in the presence of these angiographic features.