Macular Hole

A macular hole is a condition that affects the central portion of the retina known as the macula, which is responsible for sharp, central vision. Macular holes can develop for several reasons, including eye injuries, inflammation inside the eye, or-most commonly-as part of the normal aging process. As we age, the vitreous gel in the back of the eye becomes more liquefied, often leading to a posterior vitreous detachment (PVD) accompanied by floaters. In some cases, if the vitreous pulls too firmly on the macula, it can create a macular hole.

A full-thickness macular hole involves all the layers of the macula. It often begins gradually but typically results in a significant loss of central vision over time. In contrast, partial-thickness macular holes, sometimes referred to as pseudoholes, may affect only some layers of the macula. These can cause symptoms such as wavy, distorted, or blurred vision. However, in some cases, even partial holes may progress to full-thickness holes, leading to more severe vision loss.

Symptoms of Macular Hole

The severity of the symptoms of macular hole depends on whether the hole is partial thickness or full thickness, but in general may include the following:

  • Blurred central vision
  • Distorted, "wavy" vision
  • Difficulty reading or seeing fine details even with glasses
  • Grayish area in central vision
  • Central blind spot or “dark spot”

Macular Hole Treatment

The primary treatment for a full-thickness macular hole is a surgical procedure called pars plana vitrectomy. During this surgery, the vitreous gel is carefully removed from the eye to eliminate the traction pulling on the macula. A small gas bubble is then placed inside the eye to gently press against the macular hole, helping the edges of the retina come together and heal. Patients are often instructed to maintain a face-down position for several days after surgery to keep the gas bubble in contact with the macula, which is critical for optimal healing. Over time, the gas bubble is naturally absorbed by the body and replaced with the eye’s own fluids. In many cases, this procedure results in improved vision, although the degree of recovery can vary depending on the size and duration of the hole. For partial-thickness macular holes or pseudoholes, surgery may not be necessary, and careful observation may be recommended. Treatment decisions are based on the severity of vision loss, the stage of the hole, and individual patient needs.