Purpose The aim of this study was to explore the relationship between compliance with preoperative posturing advice and progression of macula-on retinal detachment (RD) and to evaluate whether head positioning or head motility contributes most to RD progression. Methods Sixteen patients with macula-on RD were enrolled, admitted to the ward, and instructed to posture preoperatively. The primary outcome parameter was compliance, which was defined as the average head orientation deviation from advised positioning. Secondary outcome parameters included the average rotational and linear head acceleration. The head orientation and acceleration were measured with a head-mounted inertial measurement unit (IMU). Optical coherence tomography (OCT) imaging was performed at baseline and during natural interruptions of posturing for meals and toilet visits to measure RD progression toward the fovea. Results The Spearman correlation coefficient with RD progression was 0.37 ( P = 0.001, r s 2 = 0.13) for compliance, 0.52 ( P < 0.001, r s 2 = 0.27) for rotational acceleration, and 0.49 ( P < 0.001, r s 2 = 0.24) for linear acceleration. The correlation coefficient between RD progression and rotational acceleration was statistically significantly higher than the correlation coefficient between RD progression and compliance ( P = 0.034). Conclusion The strength of the correlation between RD progression and compliance was moderate. However, the correlation between RD progression and rotational and linear acceleration was much stronger. Preoperative posturing is effective by reducing head movements rather than enforcing head positioning. Translational Relevance Monitoring the efficacy of preoperative posturing in macula-on RD using OCT and IMU measurements shows that a new and combined application of these technologies leads to clinically relevant insights.