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Macular Hole

The macula is the central part of the retina and is responsible for detailed vision such as reading. A macular hole is an abnormal opening in the center of the macula, and it can lead to loss of central vision.

Symptoms

Symptoms of a macular hole include blurry and distorted vision in the affected eye. The symptoms can worsen as the hole enlarges. Often, people notice the macular hole only when covering the opposite eye.

Macular hole is most commonly a disease of people over 50 years of age. As the vitreous gel in the eye undergoes changes, it can pull on the macula and pull a small hole. There may be symptoms in the early phase of this pulling. The earliest form of a macular hole can actually resolve on its own approximately 50% of the time. If a full-blown hole develops, it is unlikely to improve. Central vision is usually lost, although side vision is preserved. Macular holes are not usually a blinding disease.

Diagnosis

Macular holes can be detected with a dilated examination of the eyes by your ophthalmologist. As retinal specialists, we have tests designed to diagnose the problem and determine how much it is contributing to your visual complaint. Fluorescein angiography can assess the health of the macula. Optical Coherence Tomography (OCT) is a state of the art, non-invasive test done in the office which can demonstrate the macula and any associated hole with great precision.

Treatment

The most effective treatment for macular hole is vitrectomy surgery. During this outpatient procedure, the vitreous gel is removed from the eye with tiny instruments. The gel is replaced with gas and is eventually replaced with the eye’s natural fluid as the macular hole heals. The patient must maintain face down position for several days after the surgery in order to keep the gas in contact with the macula. There are special chairs and face rests available to help you maintain this position. You cannot fly in an airplane while the gas is in the eye because high altitudes can cause expansion of the gas which may damage the eye.

Fortunately, surgery is typically very successful in achieving hole closure and subsequently improving vision. Vision does not typically come back all the way, but a substantial improvement often occurs. People with macular holes that have been present for a longer time (more than six months) may not experience as much improvement. Also, if there are other eye diseases present, there may not be as much improvement. If you have not had cataract surgery, you will likely need cataract surgery some time after your macular hole surgery. Only with a thorough examination will your ophthalmologist know how much you are likely to improve following surgery.

Certain types of macular holes may be treated with a medication that is injected into the vitreous cavity that in early clinical studies was successful at closing some macular holes without vitrectomy.