Macular Hole

Macular Hole

Macular Hole

What is a macular hole?

A macular hole is a small break in the macula. Macula is the central area of the retina that is responsible for central vision such as reading, driving, and seeing fine details.

Our eye’s interior is filled with vitreous, a gel-like substance that fills about 80% of the eye and helps maintain its round shape. As we age, the vitreous slowly shrinks and pulls away from the retina. This is normal and some people may experience this as “floaters” or black spots in their vision.

However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina at the macular area and create a macular hole. Macular hole can also occur in people with high myopia, a history of injury to the eye or trauma, and retinal detachment.

What are the symptoms?

  • Gradual distortion or blurriness in the central part of the vision
  • Dark or grey blindspots (scotomas) in the middle part of the vision
  • Reduced vision which makes performing routine tasks such as reading difficult

How is it diagnosed?

A comprehensive eye examination will be conducted to confirm the diagnosis. This includes OCT and retinal photography, and fluorescein angiography may also be needed to determine the extent of the damage to the macula and retina.

How can it be treated?

In many cases, vitrectomy surgery is necessary to help improve vision. It involves removing the vitreous gel that is pulling on the macula and replacing it with a fluid that is similar to the fluid produced in the eye. The eye is then filled with a special gas that stays in the eye and slowly dissolves over a few weeks. The gas forms an air bubble that gently presses on the hole and encourages new tissue to heal the hole.

Following surgery, patients must remain in a face-down position for a few days to allow the bubble to press against the macula. Maintaining the face-down position is crucial for a successful vision recovery.

Visual outcome also depends on how long the macular hole has been present before the surgery.

The chances of getting a macula hole in the other eye are 10-15%. Therefore it is important to have your regular eye examination with your retina specialist.