Macular Hole

The eye contains a jelly-like substance called the vitreous. With age, the vitreous shrinks and pulls away from the surface of the retina. In most cases, this pulling away or vitreous separation occurs without any negative effect. A patient may notice floaters but no significant visual damage occurs. In some individuals, however, there may be an area where the vitreous is firmly attached to the surface of the retina. As the shrinkage and forward movement of the vitreous progresses, pulling can can be exerted on the retina, and eventually a small hole may form in the central portion of the retina (the macula), known as a macular hole. The fluid which has replaced the vitreous jell in many areas may then seep through the hole, causing a localized separation of the retina centrally. This process results in a defect or dark spot in the central vision with distortion and central vision loss resulting.

The severity of the symptoms is dependent on whether the hole is partial or full-thickness.

• Blurred central vision
• Distorted, "wavy" vision
• Difficulty reading or performing tasks that require seeing detail
• Gray area in central vision
• Central blind spot

In very rare instances, trauma or other conditions lead to the development of a macular hole. In the vast majority of cases, however, macular holes develop spontaneously. As a result, from traditional thinking there is no known way to prevent their development through any nutritional or chemical means, nor is there any way to know who is at risk for developing a hole prior to its appearance in one or both eyes.

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids.

Following surgery, patients must usually keep their faces down for two or three weeks. This position allows the bubble to press against the macula and seal the hole. At the end of the 2-3 week period of strict face-down positioning, the patient is then permitted to resume a more normal upright posture. The air bubble itself, however, may take anywhere from 6-8 weeks following surgery to completely disappear. The air bubble is gradually resorbed by the body, and the vitreous cavity is then filled with liquid produced by cells in the front of the eye.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment either during surgery or afterward.

Typically, for macular holes less than six months in duration, a vision improvement of approximately three lines on the eye chart (or 50% improvement) can be achieved. Obviously, this is an "average" visual improvement. Vision recovery varies on a patient-by-patient basis, and each patient must be evaluated on an individual basis and discuss with their physician the expectations for visual recovery. Some patients achieve only a small amount of vision recovery, while others achieve a more significant improvement.