Macular hole

Specialty of Ophthalmology

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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.

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