What is a macular hole?

The retina is the light sensing layer of tissue that lines the back of the eye.  A specialized area of the retina, called the macula, is responsible for clear, detailed vision.  The macula normally lies flat against the back of the eye, like film lining the back of a camera.  A macular hole is an abnormal opening that forms at the center of the macula over a period of several weeks to months.

What are the symptoms of a macular hole?

In the early stages of hole formation, vision becomes blurred and distorted.  If the hole progresses, a blind spot develops in the central vision, similar to the picture you would get if your camera film had a hole in it.  Side vision remains normal, and there is no pain.  It is uncommon for a macular hole to occur in both eyes.

What causes a macular hole?

Most macular holes occur in the elderly.  The vitreous gel within the eye pulls on the thin tissue of the macula until it tears.  The torn area gradually enlarges to form a round hole.  Less common causes of macular holes include injury and long term swelling of the macula.  No specific medical problems are known to cause macular holes.

What testing might be done?

Your ophthalmologist can diagnose a macular hole by looking inside your eye with special instruments.  A photographic test called flourescein angiogram may be done in order to determine the extent of the damage to the macula.

How is a macular hole treated?

Vitrectomy surgery is the only treatment that can repair a macular hole and possibly improve vision.  Unfortunately, neither medication nor laser surgery is beneficial.  Low vision devices may help people manage their daily activities if central vision is damaged in both eyes.

During vitrectomy surgery, the ophthalmologist uses delicate instruments inside the eye to remove the vitreous gel which is pulling on the macula.  The eye is then filled with a special gas bubble which will slowly dissolve.  After surgery, the patient must maintain a constant face down position for one to two weeks to keep the gas bubble in contact with the macula.  A successful visual result often depends on how well this position is maintained.  The macular hole usually closes, and the eye slowly regains part of the lost sight.  The visual outcome may depend on how long the hole was present before surgery.  Vision does not return all of the way to normal.

Some of the risks of vitrectomy include:

• infection
• bleeding
• retinal detachment
• high pressure in the eye
• some loss of side vision
• accelerated cataract formation

Do not fly in an airplane or travel up to high altitudes until the gas bubble is gone!  A rapid increase in altitude can cause a dangerous rise in eye pressure.

Surgery is not necessary for everyone who has a macular hole.  Some people who have normal vision in the other eye may not be troubled enough to want surgery.

©The American Academy of Ophthalmology