Purpose <p>To evaluate the sensitivity and specificity of Retinal Pigment Epithelium (RPE) undulations (Oscillatory sign) on Optical Coherence Tomography (OCT) and assess its potential role as a predictive OCT biomarker for RPE tears in eyes with neovascular age-related macular degeneration (nAMD).</p> Methods <p>Retrospective analysis of the patients who had RPE tears following nAMD, which were documented by multimodal imaging. All cases were evaluated for RPE undulations on OCT, and the sensitivity and specificity of the Oscillatory sign in eyes with documented RPE tears were assessed.</p> Results <p>Seventy-nine eyes out of 936 eyes with nAMD, which were analyzed, were found to have RPE tears, as documented by colour fundus photographs (CFP) and fundus autofluorescence (FAF). OCT images were analyzed for RPE undulations, a sign of oscillatory activity. Thirty-eight eyes of 79 (48.1%) eyes were found to have the oscillatory sign. Oscillatory sign showed a high specificity of 98.95% and sensitivity of 48.10% for an underlying RPE tear. The negative predictive value of the Oscillatory sign was 95.39%, and the positive predictive value of 80.85%.</p> Conclusion <p>The Oscillatory sign of RPE undulations is not sensitive, but it is a highly specific biomarker and can help facilitate the diagnosis of occult RPE tears.</p>