What is a Macular Hole?
A macular hole is a small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina. The macula provides the sharp, central vision needed for reading, driving and seeing fine detail. A hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.
Most of the eye’s interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is normal and in most cases there are no adverse effects except perhaps a small increase in floaters or specks that seem to float around.
However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a hole. Also, once the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula, blurring and distorting central vision.
Types of Macular Hole
Foveal detachments (Stage I)
Without treatment, about 50 percent of Stage I macular holes will progress.
Partial-thickness holes (Stage II)
Without treatment, about 70 percent of Stage II macular holes will progress.
Full-thickness holes (Stage III)
The size of the hole and its location on the retina determine how much it will affect a person’s vision. When a Stage III macular hole develops, most central and detailed vision can be lost. If left untreated, it can lead to a detached retina, a sight-threatening condition that should receive immediate medical attention.
Symptoms of Macular Hole
Macular holes often begin gradually. In the early stages, people may notice a slight distortion or blurriness in their straight-ahead vision. Straight lines or objects can begin to look bent or wavy. Reading and performing other routine tasks with the affected eye become difficult.
Treatment for Macular Hole
Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision. To repair this, a vitrectomy is performed. First, vitreous gel is removed to prevent it from pulling on the retina. It is then replaced with a bubble containing a mixture of air and gas. The bubble acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals.
Following surgery, patients must remain in a face-down position for up to one week. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids. Maintaining a face-down position is crucial to the success of the surgery and because it can be difficult for many people, it is important to discuss this with your doctor before surgery.
Wolfe Eye Clinic has expertise in treating macular holes. Wolfe Eye Clinic offers complete retina services throughout Iowa, including Ames, Cedar Falls, Cedar Rapids, Des Moines, Fort Dodge, Iowa City, Marshalltown, Ottumwa, Spencer and Waterloo.
Please contact Wolfe Eye Clinic at 1-800-542-7956 to ask any macular hole-related questions or to schedule an appointment with one of our retina specialists: Dr. David Saggau, Dr. Charles Barnes, Dr. Jared Nielsen, Dr. Kyle Alliman, Dr. Alex Kartvelishvili, and Dr. Paul Boeke.