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 typically more common in women and are related to aging. In almost all cases there is nothing that you did to cause the macular hole, or nothing that could have been done to prevent it from occurring.
Most of the inside of our eye is filled with vitreous, a gel-like substance in the larger back chamber of the eye. 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 other than a small increase in floaters or specks that seem to float around. In some cases, as the vitreous gel pulls away, a hole can be created in the central retina (macula) where the retina is thin. This hole creates a blind spot in the center of the vision in that eye. In some cases, as the vitreous pulls away from the retina it becomes stuck, pulling on the center part of the retina; This is called vitreomacular adhesion or traction. In this case, a hole is not yet created but the retina has trouble functioning properly due to the tugging on the center part of the retina. Unfortunately, if you develop a macular hole in one eye you are at an increased risk of developing it in the other eye.
Symptoms of Macular Holes
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, and reading and performing other routine tasks with the affected eye generally become difficult. As the hole gets bigger over time, the blind spot can grow larger.
If you are experiencing these types of symptoms, please make an eye appointment with your local optometrist to have an eye exam. If needed, they will refer you to a retina specialist at Wolfe Eye Clinic for further treatment. The Iowa retina doctors at Wolfe Eye Clinic have a vast amount of experience in treatment options for macular holes and various retina diseases, so you will be in the best hands!
Treatments for a Macular Hole
While treatment for a macular hole can vary, surgery is necessary in almost all cases to close the hole to help improve vision. This is done with a procedure called a vitrectomy. You are made comfortable with sedation in a special operating room designed to perform delicate retina surgery. This surgery may be performed at the Wolfe Surgery Center in Des Moines, or at our trusted hospitals around the state of Iowa by a Wolfe Eye Clinic retina specialist.
Small instruments remove most of the vitreous gel through tiny holes in a special white part of the eye. Fine membranes are often removed or “peeled” off of the surface of the retina to remove traction from around the hole. The vitreous is then replaced with a special gas bubble that acts as an internal temporary bandage to close the hole. In most cases the small incisions in the white part of the eye close up without needing any stitches and the eye is patched overnight. The operation is generally pain free and patients are able to return home the same day.
Recovering from Macular Hole Surgery
In many cases, you will have to position yourself face down after surgery to keep the center part of the bubble up against the macular hole as it heals. The need for face down positioning and the length of having to do this can vary depending on your situation. Some cases can be performed without any face down positioning. Your retina surgeon will guide you as to what positioning will be needed and answer any questions you may have.
As the gas is reabsorbed, the eye replaces the bubble with its own natural fluid. The duration of the gas bubble depends on which gas is used as determined by your retina surgeon. Eye drops are needed to prevent infection and aid in healing of the eye. The vision is typically blurry immediately after surgery due to the gas bubble in the eye. As the gas bubble goes away you will notice the vision improve over the next several weeks. It is important to know that you cannot fly in an airplane or go up in elevation when you have the gas bubble in the eye.
Alternatives to Macular Hole Surgery
Surgery remains the most reliable way to fix most macular holes. However, a medicine injected into the eye called Jetrea is an FDA approved drug that can be used to treat some types of macular holes. This is only used in very rare cases where a patient cannot undergo surgery. Your retina surgeon will guide you to determine if this is an option.
If you elect not to repair the hole, it will usually enlarge, making the blind spot bigger over time. The larger the hole becomes, the less likely a hole can be closed with surgery. It is natural to be apprehensive about any surgery, particularly surgery on the eye. It is important to know that most patients do well and are surprised with the ease of surgery. Retina surgeons at Wolfe Eye Clinic and our respective retina staff members are here to help answer any questions you may have regarding macular holes and other retina conditions.
Wolfe Eye Clinic is continually involved in trying to find better ways to help patients with macular holes. You can learn more about our clinical trials here.
Find a Retina Specialist at Wolfe Eye Clinic
The retina specialists at Wolfe Eye Clinic have expertise in utilizing treatment options for macular holes and for all retinal eye conditions in their Iowa locations, including Des Moines, Ames, Cedar Falls, Cedar Rapids, Fort Dodge, Iowa City, Marshalltown, Ottumwa, Pleasant Hill, Spencer and Waterloo.
If you would like more information on macular holes, you can request information here. If you would like to schedule an appointment to see our retina specialists in Iowa, please call us at (833) 474-5850.