Macular Hole

Illustration of the eye with retina, retinal blood vessels, cornea, iris, lens, and macula labeled.What is a macular hole?

A small break that develops in the macula is called a macular hole. The macula is the central part of the retina, the light-sensing tissue in each eye. The macula is responsible for sharp, straight-ahead vision. The size of the hole and its location on the retina determine the effect on your vision. There are three stages: foveal detachments (stage I), partial thickness holes (stage II), and full thickness holes (stage III, in which most central and detailed vision can be lost). Left untreated, a macular hole can progress to a detached retina, which requires immediate care.

What causes a macular hole?

As we age, the gel-like substance that fills the eyeball, called the vitreous, shrinks and pulls away from the retina. If the vitreous is firmly attached to the retina and pulls away, it can tear the retina, creating a macular hole. Fluid can seep through the hole onto the macula, impairing vision. If you have a macular hole in one eye, you have a 10-15 percent chance of developing one in the other eye.

How would I know if I had a macular hole?

The symptoms of a macular hole include:

  • Distortion or blurring of central vision
  • Straight lines or objects may appear wavy or bent
  • Reading and other routine tasks become challenging

The best way to know for sure if you have a macular hole is to have a comprehensive dilated eye exam from an eye care professional.

How is a macular hole treated?

Some macular holes heal themselves and require no treatment. However, an operation called a vitrectomy is required in many cases to help improve vision. The ophthalmologist removes the vitreous and replaces it with a gas bubble. The bubble serves as a temporary bandage that supports the edge of the macular hole as it heals. If you have this surgery, you will need to remain in a face down position for a day or two afterward (in some cases, as long as two to three weeks) to allow the bubble to press against the macula and be gradually resorbed by the eye, sealing the hole. As this happens, the eye’s natural fluids refill the vitreous cavity.

For a few months after surgery, you will be advised not to travel by air. Changes in air pressure can cause the bubble to expand, increasing eye pressure. Your recovery of vision will depend on how long you had the macular hole, with the best recovery experienced by patients who had the hole for less than six months. Your doctor will help you understand how vision recovery may happen for you.