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Macular Hole: causes, symptoms and treatment
A macular hole is a gap that develops at the macula, the small area responsible for fine vision at the very centre of the retina, and the light-sensitive tissue at the back of the eye.
What is a macular hole?
A macular hole is a gap that develops at the macula, the small area responsible for fine vision at the very centre of the retina, and the light-sensitive tissue at the back of the eye. Since the macula is crucial for central and colour vision, a macular hole can significantly impact vision as it progresses.
What causes a macular hole?
Several factors can lead to the development of a macular hole, with the most common being the normal ageing process of the vitreous gel in the eye. As the vitreous gel ages, it separates from the retina, typically without causing issues. However, in some individuals, residual gel fibres on the macula's surface contract as the gel separates. The macula's centre, being the thinnest part of the retina, can split open, resulting in a macular hole. Other causes include eye trauma, retinal detachment, and abnormal vitreous gel separation causing vitreomacular traction.
What are the symptoms of a macular hole?
Symptoms of a macular hole include:
- Straight lines appearing crooked
- A gap or dark spot in the vision
- Affected central vision, with peripheral vision remaining intact
- Usually affects one eye rather than both
To test for a macular hole, view an Amsler Grid. Cover one eye and focus on the black dot in the middle of the grid from a comfortable reading distance. If the grid appears distorted, with crooked lines, irregular shapes, or a dark central spot, it could indicate a macular hole. Immediate eye examination is recommended.
Early detection and treatment of a macular hole significantly increase the likelihood of successful treatment.
Macular Hole Stages & Treatment
Macular hole stages:
Macular holes can progress if left untreated, with various stages identified:
- Foveal detachment (Stage 1 hole): The fovea, a small cavity in the macula's centre responsible for sharp central vision, detaches. About 50% of these holes progress to full-thickness macular holes.
- Full-thickness macular hole: These holes range from stage 2 to 4, depending on their size and evolution.
Treatment:
Vitrectomy surgery is the primary treatment for macular holes, performed under local anaesthesia with sedation. During the surgery, the vitreous gel is removed from the eye, and a gas bubble is placed to aid in healing the macular hole. Post-surgery, face-down positioning for about three days may be required, depending on the hole's size.
For more details on vitrectomy surgery, visit our vitrectomy page.
FAQs
Is the timing of vitrectomy surgery for macular hole important?
Yes! Scientific evidence shows that individuals achieve better vision if surgery is performed within three weeks of symptom onset.
Can my other eye be affected?
Possibly. If the vitreous gel in the other eye has not fully separated from the macula, there is about a 20% chance of a macular hole developing in the next five years.
By understanding the causes, symptoms, and treatment options for macular holes, you can take proactive steps to maintain your eye health. If you suspect a macular hole, seek professional help promptly for the best outcome.
