Macular Hole

The macula is the central part of the retina and is responsible for the ability to see fine details. A macular hole is when a tear or opening forms in your macula. As the hole forms, things in your central vision will look blurry, wavy or distorted. As the hole grows, a dark or blind spot appears in your central vision.

Image by Jie Wang

Causes

Age is the most common cause of macular hole. As you get older, the vitreous begins to shrink and pull away from the retina. Usually the vitreous pulls away with no problems. But sometimes the vitreous can stick to the retina. This causes the macula to stretch and a hole to form.

Sometimes a macular hole can form when the macula swells from other eye disease. Or it can be caused by an eye injury.

Symptoms

  • Symptoms of macular holes vary, but can include blurred vision, a dark spot in central vision, or distortion. These symptoms may worsen as the hole grows.

  • Macular holes are most common in patients over 50 years of age. As the gel-like vitreous in the eye changes and eventually separates from the retina, it can pull on the macula, causing a small hole.

Diagnosis

A dilated exam will allow an ophthalmologist to view the macula and diagnose a macular hole. Diagnostic testing, such as optical coherence tomography (OCT), can confirm the diagnosis and provide additional information about the unique characteristics of the macular hole.

Treatment

  • A vitrectomy surgery is the most effective way to treat a macular hole. This outpatient surgical procedure is typically performed at a surgery center. The surgeon removes the vitreous gel from  the eye and replaces it with gas or air. In order to close the macular hole, the gas or air bubble must maintain contact with the macula. This is achieved by face-down positioning for several days following surgery. As the macular hole heals,  the eye replaces the gas or air with aqueous humor, fluid  normally produced by the eye.

  • Visual prognosis for macular holes is typically good following surgery to repair the hole. Depending on the location, severity, and duration of the macular hole, patients can have different visual outcomes following surgery. If a macular hole has been present for over six months prior to surgery, visual outcome may not be as good as a recent macular hole. As with any surgical procedure, there are risks and benefits that will be discussed with your physician prior to surgery.