Macular hole
What is a macular hole?
A macular hole is a traction tear in the macula, which is the centre of the retina. The retina is responsible for providing the high resolution required for everyday activities such as reading.
There are two types of macular hole: lamellar macular holes do not affect the entire thickness of the retina, while full-thickness macular holes do. There are also different stages of macular hole:
- Stage 1: detachment of the fovea (the area of the retina in the centre of the macula)
- Stage 2: full-thickness hole in the fovea
- Stage 3: the hole grows bigger
- Stage 4: the macular hole is associated with posterior vitreous detachment
Prognosis
The prognosis is very good: today, more than 90% of cases are treated successfully. In some cases, they resolve spontaneously.
Symptoms
The main symptoms of a macular hole are loss of central vision and distorted vision in one eye. The distortion causes straight lines to become wavy, such that numbers and letters seem to jump out.
Other symptoms include a central grey area, or a blind area in the central vision.
In the early stages of the disease, a yellowish lesion can be detected in the fovea.
Testing for macular hole
To diagnose a macular hole, the back of the eyes are examined. The specialist dilates the pupils then examines the retina.
Optical coherence tomography (OCT) is an examination used to determine the size of the hole, allowing the specialist to determine the prognosis and also to confirm closure of the hole post-operatively.
What causes a macular hole?
Most cases of macular hole are idiopathic, i.e. the macular hole develops in healthy patients without any evidence of other eye diseases. Macular holes are more likely to occur as you get older.
A macular hole may develop as a result of:
- myopia
- traumatic eye injury
- chronic inflammation of the macula
- intraocular surgery
Can it be prevented?
Macular holes cannot be prevented, although they can be detected in the early stages. The sooner the hole is detected, the better the visual recovery is.
Treatments
Macular holes are treated by vitrectomy (removing the innermost retinal layer); however in some cases, at an early stage, they can be treated via an intravitreal injection.
Which specialist treats it?
Macular holes are treated by ophthalmologists.


Comprehensive guide to full-thickness macular hole surgery and care
By Professor James Bainbridge
2022-07-07
Macular holes can lead to distorted vision and blind spots. If you have or think you may have a macular hole, surgery provides a promising chance of repairing it and preserving your eyesight. Professor James Bainbridge provides you with an in-depth understanding of macular hole surgery and aftercare. See more


Your guide to full-thickness macular holes and surgery
By Mr Alistair Laidlaw
2022-07-07
When a gap forms all the way through the retina, it's referred to as a full-thickness macular hole. This can cause vision to become darker and blurry but fortunately, there is surgical treatment available to close a macular hole and therefore prevent further deterioration of vision. Mr Alistair Laidlaw provides a comprehensive guide that clarifies symptoms, treatment, the success rate of treatment and more. See more


How is a macular hole treated?
By Mr Mahi Muqit
2022-07-07
Mr Mahi Muqit, ophthalmologist, explains what a macular hole is and how it is treated. See more


On the whole, macular hole treatment is required
By Ms Yvonne Luo
2022-07-07
While the effects of macular holes vary, and small ones can fix themselves, it's more common that central vision will degenerate rather than heal. Ms Yvonne Luo, leading consultant ophthalmologist and vitreoretinal and cataract surgeon, speaks to Top Doctors about how this deterioration can be treated. See more
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Mr Mahi Muqit
OphthalmologyExpert in:
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Professor James Bainbridge
OphthalmologyExpert in:
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- Retinal detachment
- Eye floaters
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Professor Tom Williamson
OphthalmologyExpert in:
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Mr Hadi Zambarakji
OphthalmologyExpert in:
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Mr Roger Wong
OphthalmologyExpert in:
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- Diabetic retinopathy
- Retinal detachment
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- Epiretinal membrane
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