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A macular hole is an eye condition that occurs in the macula, a small area located in the center of the retina. The macula is the central portion of the retina that is responsible for our straight-ahead or focused vision. The very center of the macula is also the thinnest part of the retina, making it susceptible to holes, particularly as a person ages. A macular hole is a full-thickness tissue defect that produces a gray or black spot in this area.
Although a macular hole may gradually enlarge, the surrounding (peripheral) vision is maintained and therefore vision is almost never completely lost. Most macular holes develop as a result of pulling by the vitreous gel on the delicate macular tissue. Unlike tears in the peripheral retina, a macular hole does not typically lead to retinal detachment.
Since the risk of a macular hole developing in the other eye may be as high as 10 or 15%, an examination and periodic monitoring are recommended. Simply using your eyes for visual tasks will not cause this problem to develop.
Age is the most common of macular hole causes because as the vitreous gel deteriorates with age, it separates from the macula. In some individuals who have an abnormally strong adhesion between the macula and vitreous, this separation can result in the formation of a hole. This is why macular holes are more common in those 55 years of age and older.
Other potential causes of macular holes include:
The primary risk factors for macular holes are aging, myopia, trauma, and uveitis (eye inflammation). Macular holes are also more likely to happen in women than men.
Some macular holes do not cause any symptoms at all. However, those that do tend to cause complications like:
Symptoms may come on gradually and may be more or less severe depending on the individual and the extent of the hole. They can also be caused by other retinal disorders. In any case, it is recommended that you seek treatment from a retinal specialist at the first sign of macular hole symptoms.
Vitrectomy surgery is usually required to treat macular holes. A vitrectomy is an outpatient surgery usually performed under local anesthesia that consists of removing the vitreous gel that pulled the hole open. In order to seal the hole closed, your doctor will replace the gel with a temporary gas bubble at the time of surgery. This bubble will severely limit the vision in the operated eye for a few weeks, depending upon the type of gas bubble used. The body eventually absorbs this gas bubble and replaces it with natural eye fluids.
Surgery is highly effective in achieving closure of a macular hole, though certain features including size and how long it has been present will influence the success rate. Occasionally, a hole either doesn’t close or reopens; in such cases additional surgery may be effective. Surgical success may be enhanced if you can position in a face down manner immediately after the operation for a few days, though with our current techniques there is a trend towards reducing or eliminating the need for such positioning. We can provide you with some useful tips and resources for maintaining this positioning as comfortably as possible if it is recommended.
The amount of vision that can be recovered with successful closure of a macular hole is difficult to predict. Most people do attain some degree of noticeable visual improvement, but the improvement is usually gradual (weeks to months). It is relatively common to have cataract development or progression months after surgery. Patients who elect to have surgery for a macular hole should be aware that cataract surgery may be indicated at some point in the future. Complications of macular hole surgery such as retinal detachment, infection, hemorrhage, and others are very infrequent, although when they occur, they can affect the vision and sometimes additional surgery may be needed. Your surgeon will review the risks, benefits, and alternatives of the treatment options with you and make tailored recommendations based on the unique findings of your eye, including whether any postoperative face-down positioning is recommended.