A macular hole is a small hole in the very centre of the retina.
What is a macular hole?
The retina is the thin layer of light sensitive cells that line the inner surface of the back of your eye like a film in a camera onto which images are focused. The macula is the very important small central area of the retina 1.5mm across that is responsible for central vision and seeing fine details.
Sometimes a hole can form in the very centre of the macula, which resulting in distortion, a central gap in vision and difficulty with tasks such as reading, writing, driving or watching TV.
Macular holes are different to age related macular degeneration, although both conditions affect the same overall area of the retina.
What are the symptoms of a macular hole?
Symptoms are painless and you may notice:
- Blurring and distortion of central vision (wavy/crooked)
- Wanting to close the affected ‘bad’ eye when using both eyes together
- A ‘gap’ in central vision with letters or parts of words missing as you read
What causes a macular hole?
The exact cause has not been fully determined, but an important reason is when the vitreous jelly within the eye shrinks and separates from the retina after the age of 50 and pulls on the macula. In rarer cases, macular holes can result from blunt trauma to the eye or in eyes that are extremely short sighted.
How is a macular hole diagnosed?
After dilating your pupils with eyedrops in order to obtain a view of the back of your eye, an ophthalmologist will closely examine your retina with a slit-lamp microscope in clinic.
They will also perform an OCT (optical coherence tomography) scan, which takes a high-resolution 3-dimensional cross-sectional image of the retina to determine the extent of the macular hole.
How is a macular hole treated?
A very small proportion of macular holes may close spontaneously early on, but if left alone, a macular hole will usually gradually enlarge over time and central vision will worsen until you are unable to read even large print. The peripheral vision will generally remain normal, so you will not completely lose sight in that eye. However, most cases are best served with surgical repair of the macular hole, and visual results are often better if these holes are repaired sooner when the hole is smaller.
Surgery is successful in the majority of cases and is a day-case procedure called a vitrectomy. A Consultant VitreoRetinal surgeon uses microscopic keyhole techniques to remove the vitreous gel within the eye and can be done with the patient awake or asleep. A thin layer on the retinal surface is then delicately peeled away with a fine pair of micro-forceps and a gas bubble is inserted inside the eye, after which you will be asked to position yourself face-down so the bubble can float to the back of the eye (i.e. facing the floor) for 5 days (with intermittent breaks during the day, and sleeping on one side at night) to give it the best chance of success.
Sometimes macular hole surgery is combined with cataract surgery at the same time and your ophthalmologist will be best placed to advise the optimal surgical option for your individual case.
If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert specialists are here to help.