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, like film in a camera. 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 forming a hole. This is called a macular hole and can affect vision in a variety of ways.
Symptoms and Causes
Why do people get macular holes?
Sometimes macular holes are the result of an injury or a medical condition that affects the eye, including being very near sighted. In most people, it is due to traction on the center of vision that is more likely to occur as we age.
What are the symptoms of a macular hole?
The symptoms of a 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 occur in only the eye with the macular hole. 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.
Diagnosis and Tests
How is a macular hole diagnosed?
To diagnose a macular hole, your doctor will perform special imaging tests called optical coherence tomography that gives them a cross sectional view of your retina. This tests helps diagnose a macular hole and can differentiate it from other diagnosis that may appear similar.
Management and Treatment
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.
If your vision is decreased and the macular hole is small, your doctor may recommend the use of a drug or gas bubble that is injected into the eye. This treatment helps release the traction that caused the macular hole and allows the hole to close in certain cases. The injection is not painful as the eye is numbed before the injection is performed. Not everyone is a candidate for this form of treatment, so check with your doctor.
If your vision is decreased and the macular hole is not a candidate for an injection, then 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.
The first part of the operation for macular hole treatment is to remove the gel-like fluid of the eye, which is called the vitreous. The procedure to remove it is called a vitrectomy.
The surgeon makes small openings in the eye to insert special instruments that are used to remove the vitreous. The surgeon may also remove any small pieces of tissue ("membranes") or traction near the macular hole using fine forceps. This is done to prevent anything from pulling on the macula preventing the hole from closing.
Finally, 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 one to seven days to keep the gas bubble in place and help close the hole.
Outlook / Prognosis
How successful is surgery to repair macular holes?
Surgery is successful in closing the hole in more than 95 percent of patients. However, the success rate is closer to 80 percent if the face-down position is not maintained. The amount of vision that typically is regained varies. Ask your doctor about the amount of visual improvement you might expect.