MACULAR HOLE

What is a Macular Hole?

A Macular Hole is a small round hole that develops in the centre of the macula, the highly sensitive area of the central retina responsible for detailed central vision. 

A Macular Hole can have a significant impact on your vision as the condition can affect detailed vision, damaging the ability to read, recognise faces, drive, and see colour. 

Causes of Macular Hole

Macular Hole's are related to Posterior Vitreous Detachments, in terms of the collapse of the vitreous gel in the eye.

This collapse pulls on the central area of the macula resulting in Vitreomacular Traction. Eventually, a partial hole in the macula can form, followed by the development of a full thickness hole. 

Occasionally, a Macular Hole is associated with
  • Myopia (near-sightedness) or 
  • Trauma
  • Hyperopia (long-sighted)
  • Retinal Detachment
  • Macular Swelling (cystoid macular oedema)

Symptoms of Macular Hole

A patient may experience 

Stages of Macular Hole

A Macular Hole can progressively get larger and worsen over time. This can cause the sight to become more blurred and distorted.

Vision worsens as a small disc-shaped area of retina around the hole detaches from the rest of the retina. Eventually, a dark area appears in the central vision.

Macular holes occur in three stages:
  • Foveal detachments — about 50% worsen without treatment.
  • Partial-thickness holes — about 70% worsen without treatment.
  • Full-thickness holes — almost all worsen without treatment.

How is Macular Hole Diagnosed?

Most Macular Holes are detected when patients notice distorted or reduced vision.
 
Occasionally, a Macular Hole is detected as a chance finding, for example when covering the good eye or during a routine Eye Examination by an optometrist.

The gold standard for diagnosing macular hole is now use of Optical Coherence Tomography (OCT) to provide very detailed pictures of the retina and macula.

How is Macular Hole Treated?

Most Macular Holes require surgery.

The procedure used to treat this condition is called a Vitrectomy, which may or may not include injection of gas into the eye to close the macular hole. This is done in-hospital and there may be restrictions on travel for some time afterwards.

What if Macular Hole is Untreated?

Early diagnosis and prompt treatment can offer the best chance of retaining central vision.

Nearly all Macular Holes are progressive and early surgery offers the best chance of long-term visual success.