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What is a Macular Hole?

A macular hole is a small break in the retina, the light-sensitive tissue at the back of the eye. The center of the retina is called the macula. It is this portion of the retina that gives you the detailed, colorful vision you need for reading, driving, and distinguishing faces.

What is a macular hole?

A hole in the macula can cause blurred or distorted vision. Macular holes most often occur in people over age 60.1 Age-related macular degeneration may cause similar symptoms but is a different eye disease.2

Macular hole causes

Macular holes may be caused by a variety of conditions, but the most common is aging. The eye is filled with a gel-like substance called the vitreous (or vitreous humor or vitreous body) that helps the eye keep its round shape. The vitreous attaches to the retina through tiny strands.

Aging

As you age, the vitreous shrinks. Sometimes this shrinkage causes a small piece of the retina or macula to tear off, creating a hole. At other times, the strands remain attached to the retina and break away from the vitreous. This causes the strands to contract around the macula, which also causes a hole to develop. In either case, fluid seeps through the hole replacing the vitreous, which blurs and distorts what you see.

Other causes of macular holes include:

  • Diabetic eye disease
  • Severe nearsightedness (myopia)
  • Macular pucker
  • Detached retina
  • Best’s disease (an inherited condition)
  • Eye injury2

Women are slightly more likely to develop macular holes than men.2

Macular hole stages

Doctors rate macular holes in three stages:

  1. Stage 1 is called a foveal detachment. Without treatment, about 50 percent of Stage I macular holes get more severe.
  2. Stage 2 progresses to partial-thickness holes. About 70 percent of Stage II macular holes will worsen to Stage 3.
  3. With Stage 3, full-thickness holes are present and most central and detailed vision is gone.
    The size and location of the hole determines how much it impacts vision.1,2

Macular hole symptoms

Because macular holes often begin slowly, the signs that something is wrong can be subtle.

Early symptoms include:

  • A slight distortion or blurriness in central vision.
  • Straight lines or objects look bent or wavy.
  • Reading and other routine tasks that require sight become more difficult.

However, in some cases, the vision in one eye suddenly can become noticeably blurry and distorted. If left untreated, a macular hole may lead to a detached retina, a sight-threatening condition that requires immediate medical attention.

Vitrectomy surgery

In some cases, a macular hole will seal itself. However, many cases require an operation called a vitrectomy. This surgery is often an outpatient procedure using local anesthesia. During a vitrectomy, the doctor removes the vitreous gel and replaces it with a bubble of air and gas. This bubble pushes against the edges of the macular hole, allowing it to heal.

Vitrectomy recovery

After the surgery, you must remain still in a face-down position for at least one or two days. This allows the bubble to press against the macula. Eventually, the air and gas absorb into the body and gets replaced with natural eye fluids, sealing the hole. Some patients may have to stay face-down for as long as two to three weeks. Since not everyone can lie face down, it is important to discuss this requirement with your doctor beforehand.

Vitrectomy risks

It is very common for people to develop cataracts soon after a vitrectomy, often quickly. Infection and retinal detachment during surgery or afterward are less common side-effects of the surgery.

Air travel is restricted for several months after a vitrectomy because the changes in air pressure increase pressure in the eye.

  1. National Eye Institute. Facts About Macular Hole. Available at https://nei.nih.gov/health/macularhole/macularhole Accessed February 23, 2019.
  2. All About Vision. Macular Holes. Available at https://www.allaboutvision.com/conditions/macular-holes.htm Accessed February 23, 2019.

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