What is a macular hole?

It is best thought of as a deficiency of tissue in  the retina, affecting the most visually important region called the macula. It is caused by tractional forces around the macula, after ageing changes occur in the vitreous gel of the eye. Macular hole is completely different to macular degeneration.

What are the symptoms of macular hole?

The most common symptom is simply blurring of the central part of the vision. It may start off as inability to see some of the letters in a word when reading. Eventually reading with the affected eye may become impossible. Recognizing faces may also be difficult. Sometimes distortion of straight lines may occur.

How is the condition diagnosed?

Typically the eye doctor will measure the vision, examine the eye, and usually carry out a test known as OCT. Another test, fluorescein angiography, may also be done. OCT scans show a cross section of the retina.

How is macular hole treated?

The only way it is treated is by surgery. An operation known as vitrectomy is carried out. Using small incisions in the white part of the eye, tiny instruments are used to remove the  internal limiting membrane from the retina. A special dye called Membrane Blue is used to facilitate the process. Finally, gas is injected into the eye. Cryotherapy is applied to the eye to prevent later retinal detachment.

The operation takes about an hour and is done with local anaesthetic, mostly as a day only procedure. Sometimes sutures are used, sometimes the surgery may be sutureless. The surgery is routine and very safe. Rarely complications can occur, such as retinal tears or detachments. These are usually treated at the time but occasionally do not appear until later on. Increased eye pressure can also be an issue. Further treatment would be needed in these eventualities. Late complications can include  failure of the hole to close, formation of cataract,  re-opening of the hole, macular oedema. Severe problems such as infection and bleeding are fortunately very uncommon.

What can I expect from surgery?

The eye will be initially red and somewhat sore. Most of this is resolved by six weeks. You will be required to use eyedrops during this time. For the first week, you will be asked to keep your head in a face down position for most of the time. You can hire positioning furniture to remain comfortable during the face down period » learn more. I usually ask people to do this for 50 minutes in every hour, sitting up for meals, bathroom etc. The gas in the eye blocks the vision for 1-2 weeks and then the gas absorbs into the bloodstream.

Recovery of vision is very slow. It may take 6-12 months for vision to be maximized following the surgery. It takes this long for the retina to remodel itself. Eyesight normally returns halfway back to normal from wherever the starting point was, but on occasions can be quite good.