The eye is often compared to a camera. The front of the eye contains a lens that focuses images on the inside of the back of the eye. This area, called the retina, is covered with special nerve cells that react to light, like film in a camera. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. This small part of the retina is called the macula.
Sometimes the nerve cells of the macula become separated from each other and pull away from the back surface of the eye forming a hole. This is called a macular hole.
Sometimes macular holes are the result of an injury or a medical condition that affects the eye, including being very near sighted. In most people, it is due to traction on the center of vision that is more likely to occur as we age.
The symptoms of macular hole include:
When these symptoms are caused by a macular hole, they will occur in only the eye with the macular hole. It is very rare for someone to have macular holes in both eyes.
If any of these symptoms occur, it is important to schedule an appointment with your doctor as soon as possible. The doctor will use a special instrument to look inside the eye and see whether the macula has a hole in it.
To diagnose a macular hole, your doctor will perform special imaging tests called optical coherence tomography that gives them a cross sectional view of your retina. This tests helps diagnose a macular hole and can differentiate it from other diagnosis that may appear similar.
Rarely, your doctor might recommend not treating a macular hole if it is small, if it does not cause severe vision problems, and if the eye is otherwise healthy in all other ways. The doctor might just recommend that you have eye examinations more frequently to make sure that the macular hole does not get any larger or cause other problems. It is important to keep these appointments because although the macular hole might not get worse for a while, it will almost never go away by itself.
If your vision is decreased and the macular hole is small, your doctor may recommend the use of a drug that is injected into the eye. This drug helps dissolve the traction that caused the macular hole and allows the hole to close in about half of the cases. The injection is not painful as the eye is numbed before the injection is performed. Not everyone is a candidate for this injection so check with your doctor.
If your vision is decreased and the macular hole is large then your doctor will often recommend that the macular hole be treated with surgery.
The surgical procedure for macular holes is performed under local anesthetic so the patient is awake but does not feel the procedure.
The first part of the operation for macular hole treatment is to remove this gel-like material, which is called the vitreous. The procedure to remove it is called a vitrectomy.
The surgeon will make small openings in the eye to insert special instruments that are used to remove the vitreous. The surgeon may also remove any small pieces of tissue ("membranes") or traction near the macular hole using fine forceps. This is done to prevent anything from pulling on the macula preventing the hole from closing.
Finally, the fluid in the eye is exchanged with a sterile gas, which keeps pressure on the macular hole until it heals. Patients will need to maintain a face-down position for 1 to 7 days to keep the gas bubble in place and help close the hole.
Surgery is successful in closing the hole in more than 90 percent of patients. However, the success rate is closer to 60 percent if face-down position is not maintained. The amount of vision that typically is regained varies. Ask your doctor about the amount of visual improvement you might expect.
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