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Disease

Macular Hole

Definition: A macular hole is a small break in the macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.  A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60. 

Causes and Risk Factors: Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most cases, there are no adverse effects. Some patients may experience a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.
However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Also, once the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula, blurring and distorting central vision.
Macular holes can also occur from eye disorders, such as high myopia (nearsightedness), macular pucker, and retinal detachment; eye disease, such diabetic retinopathy and Best's disease; and injury to the eye.

Signs & Symptoms:  The severity of the symptoms is dependent on whether the hole is partial or full-thickness.  

  • Blurred central vision
  • Distorted, "wavy" vision
  • Difficulty reading or performing tasks that require seeing detail
  • Gray area in central vision
  • Central blind spot

Diagnostic Testing: 

Treatment: Some macular holes seal spontaneously and require no treatment.  In many cases, surgery is necessary to close the hole and restore useful vision.  

An operation (vitrectomy) can be performed to help limit the sight problems a macular hole causes.
The macula needs to l flat on the back of the eye to receive, through blood vessels, all the nourishment it needs to work properly. The surgery is an attempt to help the macula lie flat on the back of the eye. If this is successful then often sight problems can be helped.