A macular hole is a small defect in the retinal layer that develops at the centre of the macula. The macula is a small area at the centre of your retina (the light-sensing layer of cells lining the inside of the back of the eye). The macula is responsible for your central vision and enables you to see fine details – for example, when you’re reading. A macular hole causes a visual disturbance that affects your central vision.The condition is relatively rare, it is more common in women and people over the age of 55.
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Macular hole symptoms include:
If the unaffected eye has good vision, you may not notice any symptoms of a macular hole at first, as they can begin slowly.
However, when you do start to experience symptoms, they may include:
- blurry vision
- straight lines appearing wavy or like they’re missing a piece in the centre
- difficulty reading and writing
- a blind spot in the centre of your vision
- the loss of your central vision
- flashing lights or floaters (specks or flecks) in your vision
What causes a macular hole?
As you get older, the vitreous gel begins to shrink and pull away from the retina. Usually the vitreous pulls away with no problems. But sometimes the vitreous can stick to the retina. This causes the macula to stretch and a hole to form.
The vast majority of cases develop spontaneously without an obvious cause. If a macular hole develops in one eye, there is a 5% to 15% risk of one developing in the other eye.
In addition, some people may be particularly susceptible to this process because of factors such as:
- being very shortsighted
- inflammation within the eye
- eye trauma
When to see a consultant?
The longer a macular hole is left untreated, the less likely it is that treatment will succeed. As a result, a macular hole can permanently damage your vision if treatment is delayed.
It’s therefore important to keep on top of your eye health with regular eye tests. If you suspect or have been told that you may have a macular hole, it’s crucial to book an appointment with a retinal specialist as soon as possible.
If you have been diagnosed with a macular hole, you should be seen promptly by a vitreoretinal surgeon, ideally within about 1–3 weeks. Early treatment for a macular hole, with surgery, can often restore vision.
Macular hole diagnosis
To diagnose a macular hole, your eye doctor will put drops in your eye to dilate (widen) your pupil. They will then be able to look at the inside of your eye through a special lens and take pictures using optical coherence tomography (OCT).
OCT uses laser technology to scan the back of your eye and provide a very high-definition view of the retina and macula. Your eye doctor will then use these images to confirm your diagnosis and create a treatment plan.
At The London Clinic Eye Centre, macular holes are treated by our expert vitreoretinal surgeons who can talk you through the treatment options.
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Macular hole treatments
The two main treatment options for a macular hole are observation and surgery. This is because some small macular holes may close spontaneously and so surgery is not needed.
However, the vast majority of macular holes will require an operation called a vitrectomy.
Vitrectomy
Vitrectomy (carried out by a vitreoretinal specialist) is a surgical procedure undertaken in our day surgery unit under either local or general anaesthesia. It is usually performed as a day-case procedure, meaning you should be able to go home on the same day (though an overnight stay is possible if needed).
If surgery is recommended, your surgeon will discuss the risks and benefits of surgery, explain what to expect afterwards and provide written information. Successful surgery closes macular holes in approximately 80–95% of cases, with a useful improvement in vision for around 75% of patients.
During the procedure, your surgeon will make three small keyhole incisions on the white of your eye and carefully remove the vitreous gel in the back half of your eye to stop it from pulling on the retina.
They will then place a gas bubble in your eye. This bubble presses against the retina, specifically the macular hole, helping to flatten the edges of the hole and encouraging it to seal. This gas bubble will naturally absorb within 2–8 weeks. The whole procedure takes approximately 1–2 hours.
You’ll be asked to lie face down and keep your head in a face-down position for a certain amount of time per day for a number of days (sometimes up to a week) after the procedure. This ensures that the gas bubble applies pressure to hold the edges of the macular hole closed until it heals.
During your recovery, you will not be able to fly or go to high altitudes while the bubble is in your eye.
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