Macular Hole
Other Names
Macular cyst, retinal hole, retinal tear, and
retinal perforation.
What is a macular hole?
A macular hole is a small break in the
macula,
located in the center of the eye's light-sensitive
tissue called the
retina. The macula provides the
sharp, central vision we need for reading, driving,
and seeing fine detail.
A macular hole can cause blurred and distorted
central vision. Macular holes are related to aging
and usually occur in people over age 60.
Is a macular hole the same as age-related
macular degeneration?
No. Macular holes and
age-related macular
degeneration are two separate and distinct
conditions, although the symptoms for each are
similar. Both conditions are common in people 60 and
over. An eye care professional will know the
difference.
What causes a macular hole?
Most of the eye's interior is filled with
vitreous, a gel-like substance that fills about 80
percent of the eye and helps it maintain a round
shape. The vitreous contains millions of fine fibers
that are attached to the surface of the
retina. As
we age, the vitreous slowly shrinks and pulls away
from the retinal surface. Natural fluids fill the
area where the vitreous has contracted. This is
normal. In most cases, there are no adverse effects.
Some patients may experience a small increase in
floaters, which are little "cobwebs" or specks that
seem to float about in your field of vision.
However, if the vitreous is firmly attached to
the retina when it pulls away, it can tear the
retina and create a macular hole. Also, once the
vitreous has pulled away from the surface of the
retina, some of the fibers can remain on the retinal
surface and can contract. This increases tension on
the retina and can lead to a macular hole. In either
case, the fluid that has replaced the shrunken
vitreous can then seep through the hole onto the
macula, blurring and distorting central vision.
Macular holes can also occur from eye disorders,
such as high
myopia (nearsightedness),
macular
pucker, and
retinal detachment; eye disease, such
diabetic retinopathy and Best's disease; and injury
to the eye.
Macular holes often begin gradually. In the early
stage of a macular hole, people may notice a slight
distortion or blurriness in their straight-ahead
vision. Straight lines or objects can begin to look
bent or wavy. Reading and performing other routine
tasks with the affected eye become difficult.
Are there different types of a macular hole?
Yes. There are three stages to a macular hole:
-
Foveal detachments (Stage I). Without
treatment, about half of Stage I macular holes
will progress.
- Partial-thickness holes (Stage II). Without
treatment, about 70 percent of Stage II macular
holes will progress.
- Full-thickness holes (Stage III).
The size of the hole and its location on the
retina determine how much it will affect a person's
visual
acuity. When a Stage III macular hole develops, most
central and detailed vision can be lost. If left
untreated, a macular hole can lead to a
detached
retina, a sight-threatening condition that should
receive immediate medical attention.
How is a macular hole treated?
Although some macular holes can seal themselves
and require no treatment, surgery is necessary in
many cases to help improve vision. In this surgical
procedure--called a
vitrectomy--the
vitreous gel is
removed to prevent it from pulling on the
retina and
replaced with a bubble containing a mixture of air
and gas. The bubble acts as an internal, temporary
bandage that holds the edge of the macular hole in
place as it heals. Surgery is performed under local
anesthesia and often on an out-patient basis.
Following surgery, patients must remain in a
face-down position, normally for a day or two but
sometimes for as long as two-to-three weeks. This
position allows the bubble to press against the
macula and be gradually reabsorbed by the eye,
sealing the hole. As the bubble is reabsorbed, the
vitreous cavity refills with natural eye fluids.
Maintaining a face-down position is crucial to
the success of the surgery. Because this position
can be difficult for many people, it is important to
discuss this with your doctor before surgery.
What are the risks of surgery?
The most common risk following macular hole
surgery is an increase in the rate of
cataract
development. In most patients, a cataract can
progress rapidly, and often becomes severe enough to
require removal. Other less common complications
include infection and
retinal detachment either
during surgery or afterward, both of which can be
immediately treated.
For a few months after surgery, patients are not
permitted to travel by air. Changes in air pressure
may cause the bubble in the eye to expand,
increasing
pressure inside the eye.
How successful is this surgery?
Vision improvement varies from patient to
patient. People that have had a macular hole for
less than six months have a better chance of
recovering vision than those who have had one for a
longer period. Discuss vision recovery with your
doctor before your surgery. Vision recovery can
continue for as long as three months after surgery.
What if I cannot remain in a face-down position
after the surgery?
If you cannot remain in a face-down position for
the required period after surgery, vision recovery
may not be successful. People who are unable to
remain in a face-down position for this length of
time may not be good candidates for a vitrectomy.
However, there are a number of devices that can make
the "face-down" recovery period easier on you. There
are also some approaches that can decrease the
amount of "face-down" time. Discuss these with your
doctor.
Is my other eye at risk?
If a macular hole exists in one eye, there is a
10-15 percent chance that a macular hole will
develop in your other eye over your lifetime. Your
doctor can discuss this with you.
Research
Research studies are being conducted to determine
other treatments for macular holes. Currently the
research is looking at using silicon oil to close
the macular hole instead of the gas bubble that is
being used now. No definite conclusions have been
reached at this time.
Other Resources
The following organization may be able to provide
additional information on macular holes:
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
(415) 561-8500
Distributes a fact sheet on macular hole for
patients.
For additional information, you may also wish to
contact a local library.
Courtesy of the National Eye Institute |
