Purpose To demonstrate applicability of high speed spectral optical coherence tomography (SOCT) method for imaging retinal pathologies in clinical conditions. Methods SOCT was performed in 67 eyes with different macular diseases. Examinations were carried out with the prototype SOCT instrument constructed in the Institute of Physics, Nicolaus Copernicus University, Toruń, Poland. A broadband superluminescent diode was used as a light source. Results The disturbances of retinal layer structure concerning mainly outer segments of photoreceptors were observed in case of central serous chorioretinopathy and choroidal neovascularization in age-related macular degeneration. Large drusen were often related to significant changes of outer nuclear layer thickness and reflectivity. Conclusions SOCT detects small disturbances of the retinal structure and helps to precisely determine layers involved in different pathologies. (Eur J Ophthalmol 2007; 17: 238–45)