What is a Macular Hole?

To get a better understanding of macular holes and their consequences please view this macular hole slide show.Thanks!

A macular hole is a tear in the macula lutea, a pigmented area of the retina that is responsible for central vision and visual acuity, or clarity of vision. Your doctor may also refer to this condition as a macular cyst – or a retinal hole, tear or perforation. Macular holes tend to occur most often in older people, the majority being women over age 60.

What Causes a Macular Hole?

A number of things can cause a macular hole, including acute trauma. The most common cause, however is related to aging. The vitreous humour – vitreous, for short – is a gel that fills the space between the retina and the lens of the eye. It tends to shrink as we get older, much the same way that gelatin shrinks away from the side of the pan or bowl if we leave it to sit too long.

Most of the time there is no harm to this shrinkage, but sometimes the vitreous humour can be stuck firmly to the retina in one spot. As the vitreous shrinks it pulls on the retina too, eventually creating a small tear in the macula.

What are the Symptoms of a Macular Hole?

Symptoms include floaters (small, dark lines or spots) and flashes of light, blurred vision, seeing straight lines and objects as curved or wavy, and having a blind spot or darkened area in the middle of the eye. Peripheral vision is not altered. Vision in the unaffected eye will not change.

A macular tear makes it difficult to read, drive, or perform other tasks that require the individual to see details clearly.

Retinal diseases like a macular hole don’t generally cause pain, and symptoms may seem fairly mild at first. It is important not to ignore them, however, because left untreated some of these conditions can cause permanent damage including blindness.

Is a Macular Hole the Same as Macular Degeneration?

No, these are two separate conditions. Both tend to occur more in older people. Their symptoms are also similar. Sometimes people who have macular degeneration also have a macular hole. Your eye care specialist will be able to tell the difference between them, and should be consulted for any concerns or change in vision.

Can a Macular Hole be Treated?

Macular holes were once considered untreatable. Today it is common to use microsurgery to remove the vitreous humour. This surgery is called a vitrectomy, and is done by a retinal specialist. It is most often performed as a day surgery, often under local anaesthesia.

Vitrectomy involves removal of the vitreous, paying particular attention to the part that is attached and tugging on the retina. A gas bubble is then injected into the space behind the retina. This gas will be absorbed into the body over a period of weeks, and liquid will fill up the space it leaves. The gas holds the retina in place while it heals, just like stitches hold the edges of a wound together or a cast holds a broken bone in place while it knits itself together.

Vision improves over time, but may remain impaired for several weeks or months after the procedure. Vitrectomy is successful in about 70 to 90 percent of cases, but the amount of improvement will vary from patient to patient. Most people will see an improvement equivalent to about two or three lines on a vision chart. Surgery is most effective if performed within six months after the hole develops.

Risks of the surgery include infection, retinal detachment, and fast growing cataracts. Patients should avoid air travel for several months after surgery, as changes in air pressure can affect pressure within the healing eye as well.

Surgery is the only recognized treatment for a macular hole. Medications and lifestyle changes are not thought to prevent or lessen the severity of a macular tear. Some will spontaneously close up, but there is no way to predict which ones will – just as there is no way to predict who will develop a macular hole.

Do I Really Have to Lie on My Face for Several Weeks?

The gas bubble tends to rise, so moving around means that pressure on the retina during healing may not be sufficient to restore vision. Many doctors recommend what is called “face-down positioning” for anywhere from 7-10 days, up to three weeks after the surgery. There are a number of therapeutic supports that make it possible for patients to perform activities of daily living while maintaining the face-down orientation. It is not necessary to lie face down in bed the whole time!

Some doctors do not feel the face-down positioning is necessary, or will offer an alternative in which oil is injected into the eye instead of gas. This does require a second surgery to drain off the oil once the retina heals, but it is an important option for those unable to maintain the face-down posture.

What About My Other Eye?

There is a slightly increased risk of developing a macular hole in the second eye, but no way to prevent or predict its occurrence.

It is important that everyone have regular eye exams with a qualified professional. Individuals who are at risk for retinal diseases should see their eye care specialist promptly if they note any worsening of vision or any of the symptoms listed.

Disclaimer:

This article is provided for information purposes only, and is not intended to replace examination and advice from a qualified health provider.

Sources:

“Facts about macular hole” National Eye Institute (NIH)

Floaters and flashing lights” Canadian Ophthalmological Society
“Macular hole” Angeles Vision Clinic

“Macular hole” Columbia Ophthalmology Consultants (Columbia University Medical Center)

Retinal diseases symptoms” Mayo Clinic

“Today’s treatment for macular holes” St. Luke’s Eye Clinic

Reference:

• Eye Tests www.mdsupport.org/eyetests.html
• Talking to Your Doctor www.nei.nih.gov/health/talktodoc.asp
• Macular Hole Slide Show www.associatedcontent.com/slideshow/44997/vision_and_the_macular_hole.html?cat=70