Macular Hole

If you have been diagnosed with a macular hole, you’ll be aware of the frustrating symptoms it can cause.

Your eyesight becomes blurry in the centre, and lines that ought to be straight can start to look wavy or distorted. You may even notice a dark patch in the middle of your vision. There’s no question that these kinds of symptoms can be very worrying. But if you do find yourself with the condition, there is a lot we can do to help. Our macular hole treatment provides a highly effective option for arresting the cause of the problem and restoring lost vision.

A macular hole – not to be confused with macular degeneration – is a tiny gap that develops in the macula, a highly light-sensitive area in the centre of your retina (the retina is a layer of nerves at the back the eye which receives light and converts it into signals for the brain).

The macula is responsible for our central vision. It allows us to see fine detail for activities like reading, recognising faces, watching TV and driving. It also enables us to see colour.

The hollow ball of the eye contains vitreous. This is a clear, jelly-like substance that fills the hollow space behind the lens. As we age, this vitreous gel becomes more opaque and starts to shrink away from the retina. This is very common: it affects around 75% of people over the age of 65.

This separation of the vitreous gel is known as Posterior Vitreous Detachment (or PVD). It doesn’t cause any permanent loss of vision in the eye (though floaters may be troublesome).

Occasionally the vitreous jelly shrinks but doesn’t separate from the retina. This may cause it to pull on the macula, resulting in swelling and later – potentially – a macular hole. We call this vitreomacular traction.

We can use an Optical Coherence Tomography (OCT) to see if this has happened to your eye. An OCT is a non-invasive imaging technique which provides a cross-sectional image of your retina.

Fundus images of a normal macula and a macular hole
OCT image of a macular hole showing the swollen retina around the hole lifting away from the eye wall.

Most macular holes are idiopathic – that is, we can’t be sure exactly what causes them to develop. One possibility is that, as the vitreous jelly within the eye shrinks, it pulls on the macula. This may result in swelling, followed by the emergence of a full-thickness hole.

Macular holes are most common in older people, particularly women; most occur spontaneously in women around the age of 70.

Macular holes are also occasionally associated with myopia (short-sightedness) or trauma. Vision worsens as a small, disc-shaped area of retina around the hole detaches from the eye wall. It’s this localised detachment that causes many of the troublesome symptoms – and which we can address with surgery.

There are several common symptoms of a macular hole:

  • blurred central vision
  • objects appearing “pinched in” and reduced in size
  • distortion of straight lines

Nearly all macular holes are progressive – that is, they get worse over time if left untreated. Early surgery offers the best chance of long-term visual success.

Occasionally a hole might be detected as a chance finding, for example when you are being examined by an optometrist. But even when few symptoms are present, we may recommend surgery to prevent further deterioration and to give you the best chance of long-term success.

The procedure we use to treat macular holes is called a vitrectomy. It involves removing the jelly, then filling the eye with an inert gas. This pushes back the small area of retinal detachment around the macular hole, effectively causing it to “close”. Closing the hole should lead to improved visual function.

If you have developed a macular hole in one eye, you may be at greater risk of developing a hole in the other eye, too. The risk depends on the position of the vitreous gel; if the fellow eye has yet to develop a posterior vitreous detachment then the chance of a macular hole forming can be as high as one in six.

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