Retina Institute of Indiana, P.C.

Macular Hole

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What is a macular hole?
A macular hole is a small break in the macula, the part of your eye responsible for detailed, central vision. The macula is a very small area at the center of the retina — a thin layer of light-sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see. It is the macula that is responsible for your pinpoint vision, allowing you to read, sew or recognize a face.

As we age, the vitreous gel inside of the eye shrinks and pulls away from the macula, usually with no negative effect on your sight. In some cases however the vitreous gel sticks to the macula and is unable to pull away. As a result, the macular tissue stretches.

After several weeks or months the macula tears, forming a hole. Macular holes are associated with aging and usually occur in people over the age of 60. Less common causes of macular holes include injury to the eye and long-term swelling of the macula.

Who is at risk of developing a macular hole?

Currently there isn't any any way to know who is at risk for developing a hole prior to its appearance in one or both eyes, although age is always a factor.

The presence of another eye condition may increase your chances of developing a macular hole. These include:

* Severe short sightedness
* Epiretinal membranes that progress to the ‘macular pucker’ stage
Retinal detachment
* Diabetic retinopathy

* Eye injury or trauma

What are the symptoms of a macular hole?

The symptoms usually are:

•   Decreased ability to see fine details when looking directly at something at any distance;
•   Vision distortion similar to looking through thick fog or wavy glass.
•   A dark or blind spot in the center of the field of vision.

How is a macular hole treated?

It is important to note that if the macula is damaged, you will not lose your vision entirely. You will still have peripheral, or side vision. A test called optical coherence tomography (OCT) is most helpful in making an accurate macular hole diagnosis. With OCT, a special diagnostic laser camera is used to photograph your retina. It measures the thickness of the retina and is also very sensitive at detecting swelling and fluid. OCT can also diagnose small macular holes that are too small to be seen in an examination or with angiography.

Macular hole surgery involves using tiny instruments to remove the vitreous gel that is pulling on the macula. The eye is then filled with a special gas or oil bubble to help flatten the macular hole and hold the retinal tissue in place while it heals. The bubble will then slowly dissolve on its own, or, in some cases, be removed by your doctor.

As the macular hole closes, the eye usually regains some of the lost sight. How much vision is restored generally depends on the size of the hole and how long it was present before surgery.