Macular hole

A macular hole is a tiny hole in the macular (the centre of the retina), which can affect your central vision, including objects straight ahead, your colour vision and your ability to see fine details like small objects and when driving or reading.

Symptoms of macular hole

People with a macular hole may experience a difference in their central vision. It often affects one eye, while the peripheral (side) vision remains unaffected.

The common symptoms of a macular hole include;

• Blurry or distorted vision
• Difficulty watching TV, reading or doing close-up work
• Straight lines appear bent or kinked
• A blank or dark sport in the central vision

These symptoms usually vary, depending on the depth and size of the macular hole. You may not experience any pain and retain some vision, but visiting an optometrist for treatment when you notice these symptoms is important.

Causes of a macular hole

Many eye problems can affect the macula and cause loss of central vision if left untreated. These include a macular pucker or epi retinal membrane(ERM), macular oedema and a macular hole. It is usually unclear what causes a macular hole, but the condition is linked to other conditions, such as:

• An eye injury
• Long-lasting macular swelling (cystoid macular oedema)
• Long-sightedness or hyperopia
• Severe short-sightedness or myopia
• Retinal detachment

Another cause of a macular hole is changes in the gel-like fluid that fills the eye, known as the vitreous, that attaches to the retina through several small fibres. As you grow older, the vitreous begins to shrink and pull away from the retina, which is normal and shouldn’t cause any problems.

Experts believe that as the vitreous jelly detaches from the back of the eye (posterior vitreous detachment), the areas that aren’t firmly attached to the retina may pull the macular enough to create a small hole.

How to diagnose a macular hole

If you experience the symptoms above, ensure you visit an optician immediately. If the optician suspects a macular hole, they will refer you to an ophthalmologist for more tests.

The ophthalmologist will put dilating eye drops in your eye to examine the back of your eye and use an OCT scan to check the structure and thickness of your retina. This will help diagnose a macular hole or rule out other conditions.

If you have a macular hole, the ophthalmologist will determine the right treatment for you, if necessary or recommend monitoring your eye for some months.

How can a macular OCT scan help?

The OCT scanner can create 3D cross-sectional images of your eye, allowing the optometrist to check the eye in detail, including different retina layers.

Some people may not know they have a macular disease until the condition advances and their central vision is blurry or distorted. Regular visits to an optician are important to detect early macular condition signs.

An OCT scan is a painless and quick test that efficiently detects macular conditions.

Surgery for a macular hole

If the macular hole is in the early stages, the ophthalmologist may choose to monitor your eye changes over time. If treatment is necessary, it often involves surgery that aims to repair the hole and enhance your vision, but in most cases, your vision will not return to normal.

• Vitrectomy

This surgery repairs a macular hole. It involves removing the vitreous gel in the eye and replacing it with gas bubbles to aid healing in the macula. Removing the vitreous prevents it from further pulling on the retina, and the bubble lightly presses on the hole, aiding its healing.

The gas bubbles may blur your vision, but within a few weeks, the bubble will become smaller and eventually disappear. Within this period, your eye will naturally produce some fluid to replace it.

Recovering after macular hole surgery

You will get eye drops for some weeks, and do not rub your eyes, swim, do strenuous exercises and wear make-up during recovery.

When the gas bubbles are still in your eye, your vision will be poor, so you can’t drive for a couple of weeks, and you need to be careful during your daily activities.

Avoid going to high altitudes or flying until the bubble disappears because the pressure will make the bubble expand, which may permanently affect your vision. If you have other procedures while the gas hasn’t disappeared, inform your doctor because the gas can react with other substances.

Your eye doctor may want you to position yourself in a particular way during the day to allow the bubble to remain in contact with the back of the eye. This is known as posturing and involves sitting at an angle or lying on your front. It may seem demanding, but your specialist will advise you on the best way to do this.

Like any kind of surgery, macular hole surgery has a risk of complications, and the specialist will inform you. Cataract development is among the most common complications after macular hole surgery, which requires another surgery.

If, after the surgery, you are concerned about additional symptoms or experience eye pain, contact your ophthalmologist or visit the nearest eye casualty department.

At Optimal Vision, our ophthalmologist will offer you the right treatment if you have a macular hole. You can contact us at 020 7183 3725 to schedule an appointment with an eye doctor for an eye exam if you experience macular hole symptoms.

Is a macular hole treatable?

About 90% of people with a macular hole can have a successful treatment with surgery to repair the hole within six months. The treatment aims to close the hole, which may improve vision but is unlikely to restore vision completely.

How long is recovery after macular hole surgery?

Full recovery following macular hole surgery often takes 6 – 8 weeks.

How serious is a macular hole?

A macular hole only affects central vision (this will affect the details of things you look at), but peripheral vision is normal. The amount of detail lost will depend on the size and stage of the hole.