Macular hole

What is the retina?

  • If the eye were a camera, the retina would be the film of that camera

  • The retina is a thin sheet of nerve cells that lines the inside back wall of the eye

  • Light travels through the eye and ultimately reaches photoreceptors, the light-sensitive cells in the retina

  • The signal from the photoreceptors then travel along the optic nerve to the brain, where the signals are interpreted as vision

What is the macula?

  • The macula is the center region of the retina

  • The macula is responsible for high detail vision, central vision, reading, etc. The rest of the retina is responsible for peripheral vision.

  • AMD affects the macula, and in turn, results in decreased vision for tasks like reading, driving, recognizing faces, etc.

The macula (yellow circle shown) is an area in the center of the retina.

What is a macular hole?

  • A full-thickness defect (hole) in the macular region of the retina

Left image: Optical coherence tomography (OCT) scan through a normal, healthy retina. Notice the tissue is continuous with clear dark and light bands and a dip in the center signifying the foveal dip, responsible for crisp, clear vision. Right image: There is a full thickness defect, or hole, in the central retina (a gap in the tissue).

How does a macular hole affect vision?'

  • Decrease in central vision

  • Dark spot in the middle of the vision

  • Missing letters when reading a word

What causes a macular hole?

  • Most macular holes are due to abnormalities in the aging process of the eye, whereby tractional forces pull on the fovea at the center of the macula and allow a hole to develop

  • Macular holes may also occur in eyes after trauma

How is a macular hole treated?

  • Full thickness macular holes may rarely close on their own. In very small macular holes with specific clinical features, a trial of eye drops may help facilitate closure.

  • Most full thickness macular holes, however, require surgery for closure

What is macular hole surgery?

  • Pars plana vitrectomy

  • Outpatient, day surgery

  • Micro-incisional surgery whereby the microscopic tissues creating traction on the retina are peeled gently from the fovea and removed. This relieves traction on the hole

  • A gas bubble is placed in the eye and patients typically maintain a face down position for several days to help support macular hole closure

  • Vision is poor through a gas bubble, but the gas will dissipate on its own, usually over 2-3 weeks (possibly longer if a longer acting gas bubble is used)

Left image: An optical coherence tomography (OCT) scan reveals a full thickness defect in the center due to macular hole. The patient’s vision is 20/200. Right image: An OCT image after surgical repair of the macular hole in the same patient shows closure of the macular hole. Vision improved to 20/40.