What is a macular hole?
The eye is often compared to a camera. The front of the eye contains a lens that focuses images on the inside of the back of the eye. This area, called the retina, is covered with special nerve cells that react to light. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. This small part of the retina is called the macula.
Sometimes the nerve cells of the macula become separated from each other and pull away from the back surface of the eye. This is called a macular hole.
Why do people get macular holes?
Sometimes macular holes are the result of an injury or a medical condition that affects the eye. In some people, it seems to be a side effect of the changes that normally occur in the eye as we age. The cause of most macular holes, however, is not known.
How does a doctor know whether someone has a macular hole?
The symptoms of macular hole include:
- A decrease in the ability to see fine details when a person is looking directly at an object, no matter how close or far away it is.
- A change in vision that makes a person feel like he or she is looking through a dense fog or thick, wavy glass.
- The appearance of a dark spot across the middle of the field of view.
When these symptoms are caused by a macular hole, they will usually occur in one eye only. It is very rare for someone to have macular holes in both eyes.
If any of these symptoms occur, it is important to schedule an appointment with your doctor as soon as possible. The doctor will use a special instrument to look inside the eye and see whether the macula has a hole in it.
Is there any treatment for macular hole?
Rarely, your doctor might recommend not treating a macular hole if it is small, if it does not cause severe vision problems and if the eye is otherwise healthy in all other ways. The doctor might just recommend that you have eye examinations more frequently to make sure that the macular hole does not get any larger or cause other problems. It is important to keep these appointments because although the macular hole might not get worse for a while, it will almost never go away by itself.
Usually your doctor will recommend that the macular hole be treated with surgery.
What happens in the operation to treat a macular hole?
The surgical procedure for macular holes is performed under local anesthetic so the patient is awake but does not feel the procedure.
One theory about the cause of macular holes is that the gel-like fluid that fills most of the inside of the eye is pulling on the macula. Thus, the first part of the operation for macular hole treatment is to remove this gel-like material, which is called the vitreous fluid. The procedure to remove it is called a vitrectomy.
The surgeon will make small openings in the eye to insert special instruments that are used to remove the vitreous fluid. The surgeon will remove the fluid and any small pieces of tissue ("membranes") near the macula. This is done to prevent anything from pulling on the macula preventing the hole from closing.
The fluid in the eye is exchanged with a sterile gas, which keeps pressure on the macular hole until it heals. Patients will need to maintain a face-down position for 1 to 2 weeks to keep the gas bubble in place and help close the hole.
How successful is surgery to repair macular holes?
Surgery is successful in closing the hole in more than 90 percent of patients. However, the success rate is closer to 60 percent if face-down position is not maintained. The amount of vision that typically is regained is variable. Ask your doctor to estimate the chance and amount of visual improvement you might expect.