A macular hole is a small tear in the macula – the central part of the eye’s retina, or light sensitive layer. The macula is the part of the eye that is responsible for the sharp, central vision we use for reading, driving and other fine detail, such as seeing people’s faces.
Most macular holes enlarge slowly over time causing central vision to deteriorate. However, even if left untreated, most macular holes never result in complete blindness. There is no pain associated with a macular hole and peripheral vision remains normal.
Macular holes often form gradually and may not be noticed at first. Some people notice blurriness or distortion in their central vision. Straight lines can become wavy and some tasks such as reading can become difficult in the affected eye.
The eye is filled with a clear gel-like substance called the vitreous. As people begin to age, the vitreous becomes more liquefied and can start to pull on the macula. This is one of the most common causes of a macular hole.
People with a high level of myopia may also develop a macular hole, as the elongation of the eyeball can put stress on the macula, causing it to tear.
Other causes include diabetic eye disease, eye injury or trauma, and certain retinal and macular disorders.
Most patients who develop macular holes are aged 60 or over, with a significantly higher incidence in women. Occasionally macular holes may develop in younger patients, but this is most often due to trauma to the eye.
Occasionally, a macular hole will heal itself.
If treatment is required, a surgical procedure called a vitrectomy can be performed by an eye surgeon, In this procedure, the vitreous jelly is removed to stop it pulling on the macula. A mixture of air and gas is then inserted into the space once occupied by the vitreous. This bubble puts pressure on the edges of the hole allowing it to heal. The eye will then refill naturally with fluid.
This is usually done as an outpatient surgery and takes approximately one hour to perform. After surgery, the patient will need to lie face down for one to two days.
Patients can usually resume normal daily activities within 24-48 hours.
Following surgery, successful healing of the hole occurs in about 90% of cases. Most patients experience some degree of noticeable visual improvement. Visual recovery occurs quite slowly and can take between three to six months.