Macular Holes

A macular hole is a defect in the portion of the retina responsible for sharp central vision and fine details. When the macula develops a hole or tear, it can cause blurry and distorted vision, making it difficult to read, drive and perform other daily tasks. If left untreated, a macular hole can cause serious complications, such as a detached retina, that have irreversible consequences.

Cases of macular holes should be evaluated and treated by retina specialists — ophthalmologists with special training and experience in disorders affecting the macula, retina and vitreous. The treatments performed by retina specialists are exacting and delicate, and require a specific set of skills.

Causes

Macular holes often develop due to the aging process. With age, the clear, jelly-like substance that fills the inner chamber of the eye (known as the vitreous) shrinks. The vitreous is attached to the retina by small strands of cells. As it shrinks, it can start to pull on the surface of the retina; sometimes it causes a small piece of the retina to tear. If the missing piece is located in the macula, it is known as a macular hole. Another scenario that can possibly occur is that some of the cellular strands stay attached to the retina and contract around the macula. The tension leads to a small tear. Fluid then leaks through the macular hole, causing blurring and distorted vision.

Aging is the primary risk factor for macular holes; they are more likely to occur in adults over the age of 60. Other risk factors include severe nearsightedness, diabetic eye disease (e.g., diabetic retinopathy), macular puckers and retinal detachment. Macular holes can also develop after a traumatic eye injury.

Symptoms of a Macular Hole

The symptoms of a macular hole include blurry or distorted central vision, dark spots appearing in the central vision, straight lines appearing “wavy” or bent and difficulty performing routine tasks such as driving and reading. Symptoms tend to worsen as the macular hole grows or develops. The size and location of the macular hole determines how badly it affects vision.

Macular holes are diagnosed by a comprehensive eye examination and evaluation of the patient’s symptoms, medical record and eye health history. Tests such as optical coherence tomography are performed to provide cross-sectional images of the eye to identify the macular hole.

Macular Hole Treatment

Some macular holes are very small or resolve naturally and do not substantially interfere with vision. These cases typically do not require treatment intervention, but it is advisable to have a retina specialist monitor the eye for any progression. Regular appointments are necessary to identify potential problems or growth and intervene if needed.

When a macular hole begins to interfere with daily activities, surgical treatment becomes appropriate. Vitrectomy is the most common treatment for macular holes. The procedure involves removing the vitreous gel from the eye to stop it from tugging on the retina. In most cases, a gas or oil bubble is placed in the eye to put pressure on the macular hole and keep the edges closed until it heals. After surgery, gas bubbles gradually dissolve and are replaced with natural eye fluid. Vitrectomy patients may be required to hold their head in a specific position until the bubble dissolves.

People with a macular hole in one eye have a 10 percent chance of developing a macular hole in the other eye. These patients should be monitored regularly by a retina specialist in order to catch any problems early and start intervention.

Is Blurry Vision Affecting Your Daily Life?

Have you noticed a decline in the sharpness of your vision, or developed blind spots that prevent you from seeing clearly? The problem could be your macula or another portion of your retina. Contact our retina specialists today to schedule an examination and discussion of your symptoms. If we detect a problem, we can explore appropriate solutions.