Macular hole

Macular holes are a serious condition affecting central vision that can occur in one or both eyes. This requires the evaluation of a retinal specialist to discuss the risks and benefits of treatment.


What is a macular hole?

A macular hole often refers to a full-thickness defect in the retina at the fovea, the part of the retina where light is focused to allow for detailed color vision important for reading and driving. It leads to a decline in central vision, and often causes a central blindspot or scotoma.


What causes a macular hole?

Macular holes develop as a result of forces exerted at the fovea at sites of abnormal vitreous traction during vitreous liquefaction and separation. This vitreous change occurs with age, and eventually leads to a posterior vitreous detachment. Sometimes, a full-thickness hole develops at the fovea prior to a posterior vitreous detachment occurring, and this leads to a disruption of central acuity. Sometimes macular holes develop in younger patients in the setting of ocular trauma.



What are the symptoms of a macular hole?

Some will note blurry vision or central visual distortion (metamorphopsia). Some will note a central scotoma.


How is a macular hole diagnosed?

A dilated eye exam utilizing hand-held lenses, and optical coherence tomography of the retina.



What are the treatments for macular holes?

Vitrectomy surgery is often necessary for the macular hole to close. A gas bubble is placed in the eye, and face down positioning after surgery can help increase the chance of successful surgery. Cases more recalcitrant represent chronic macular holes more than a year old, and ones associated with a retinal detachment. Newer surgical techniques have improved the success rates of even these more challenging cases. If a hole is very small, and not affecting central vision greatly, observation with close follow-up may be warranted.