What is a macular hole?The macula is the small area in the center of the retina responsible for your central vision which helps you to perform tasks such as reading, driving and close-up work. A macular hole is a small break in the macula.
There are three stages of a macular hole:
- Foveal detachment (Stage I)
- Partial-thickness hole (Stage II)
- Full-thickness hole
Causes and Symptoms of Macular Hole
Macular holes typically affect people over age 55 and occur more often in women. Several conditions increase the risk of developing a macular hole:
- Vitreous traction: The vitreous is the clear, jelly-like substance that fills the middle of the eye between the lens and the retina. As you age, the vitreous can begin to pull away from the retina, sometimes causing a macular hole.
- Injury or trauma to the eye
- Diabetic eye disease
- High degree of myopia (nearsightedness)
- Retinal detachment
- Macular pucker
Symptoms of a macular hole can include:
- Decline in central vision
- Blurring of vision
- Distortion, causing straight lines to appear wavy
- A dark spot in your central vision
Ocular coherence tomography (OCT) is used for diagnosing, staging and managing a macular hole.
Treatment and Prognosis
The standard treatment for macular holes is vitrectomy surgery, an outpatient procedure that involves removing the vitreous gel to stop it from pulling on the retina[1, 2] (Kelly and Wendel 1991; Wendel et al. 1991). A gas bubble is then placed in the eye to push against the macular hole, helping it to close and heal (Funata et al. 1992). Over a period of several weeks, the gas bubble slowly dissolves and is replaced with natural eye fluids.
If a macular hole is very small and is not significantly impacting vision, your retina doctor may simply observe and track its progression or natural healing.
- Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991 May;109(5):654-9. https://pubmed.ncbi.nlm.nih.gov/2025167/
- Wendel RT, Patel AC, Kelly NE, Salzano TC, Wells JW, Novack GD. Vitreous surgery for macular holes. Ophthalmology. 1993 Nov;100(11):1671-6. https://pubmed.ncbi.nlm.nih.gov/8233393/
- Funata M, Wendel RT, de la Cruz Z, Green WR. Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina. 1992;12(4):289-98. https://pubmed.ncbi.nlm.nih.gov/1485013/