Asheesh Tewari, MD the Retina Expert :: Patient Education
Patient Education :: Macular Hole

What exactly is a macular hole?

The macula, which is a specialized area of the retina, is responsible for clear, detailed vision. A macular hole is an abnormal opening that forms in the center of the macula over weeks to months.

What causes a macular hole?

Macular holes in most cases are caused by one of the following problems:
1. The vitreous jelly within the eye pulls on the macula until it tears.
2. Sometimes scar tissue on top of the retina can cause a macular hole.

What are the symptoms of a macular hole?

Macular Hole Diagram 01

Symptoms vary from patient to patient, but the most common symptoms are blurred and distorted vision. Sometimes patients notice a blind spot in the central part of the vision. Typically the side vision remains normal.

How do you diagnose a macular hole?

A macular hole can be diagnosed by a thorough ophthalmologic examination along with the use of photographs. For the photographic test, a fluorescein angiogram may be performed. This dye test can sometimes determine the amount of damage in the macula, or the center part of the vision.

What is the treatment for a macular hole?

Neither medication such as drops, nor laser treatment is effective for macular holes. The only known effective treatment to close the hole and improve the vision is vitrectomy surgery. During the vitrectomy surgery the vitreous jelly that pulls on the retina is removed and in most cases, the eye is filled with a gas bubble. This gas bubble will slowly dissolve after surgery. In order for the hole to close, the patient must maintain a facedown position following surgery to keep the gas bubble in contact with the macula. A successful result is often dependent upon how well this positioning is maintained. Once the macular hole closes, the eye slowly regains some sight. The amount of sight recovered depends on how long the hole was present before surgery and other factors that are unique to each case. If it is difficult for the patient to maintain a facedown position because of arthritis or another medical condition, in some cases a substance called silicone oil can be used to close the hole. This substance typically stays in the eye for six to twelve weeks following surgery and then is removed once the hole is closed after six to twelve weeks. Using silicone oil eliminates the need for facedown positioning, which is necessary when a gas bubble is used. If silicone oil is used, you will require a second surgery to remove the oil, unlike the gas bubble that goes away on its own.

Do I need surgery for a macular hole?

Surgery is not necessary for everyone who has a macular hole. In some patients who have normal vision in the other eye, they may not be troubled enough to want surgery. This surgery is an elective procedure and can be done if one desires. In about 5% to 7% of patients, macular holes can develop in both eyes.