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Macular Hole | Causes, Symptoms, and Treatment

A macular hole is a hole that develops on the retina, and can occur as a result of the vitreous gel inside the eye separating from the retina. Find out more about what causes a macular hole, when to seek professional help, and the treatment options available below.

If you have questions about macular hole and the treatment options that are available, please call us on 0203 369 2020, or request a call back.

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macular hole OCT

What is a macular hole?

A macular hole is a hole or gap that develops at the macula which is the small area that enables fine vision at the very centre of the retina. The retinal is the light sensitive tissue at the back of the eye. Since the macula is responsible for our central vision and most of our colour vision, a macular hole can have a significant impact on vision as it develops.

What causes a Macular hole?

Macular holes have a risk of developing due to a few causes, the commonest of which relates to the normal ageing change of the vitreous gel in the eye. Ageing of the vitreous gel leads to its separation from the retina, which often does not cause problems.

However, in some people, as the gel separates from the retina, it can leave residual gel fibres on the surface of the macula that contract. As the very centre of the macula is the thinnest part of the retina, the contraction of the gel fibres cause it to split open, resulting in a macular hole.

Other causes include eye trauma, retinal detachment, and abnormal separation of the vitreous gel from the retina causing vitreomacular traction.

What are the symptoms of a macular hole?

There are a few ways to tell whether a macular hole is developing. Common symptoms include:

  • Straight lines appear crooked
  • A gap or dark spot in the vision
  • Central vision is affected but the peripheral vision isn’t
  • Usually, one eye is affected rather than both

A way to test for a macular hole is to view an Amsler Grid. Cover one eye and look at the black dot in the middle of the grid from a comfortable reading distance. If the grid appears to have crooked lines, irregular shapes, or a dark central spot; this could be a symptom of a macular hole, so we recommend having your eyes checked immediately.

It is always best to see an eye specialist if you’re unsure whether a macular hole is developing in your eye. It’s best to detect and treat a macular hole early for the highest likelihood of the treatment succeeding.

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Macular hole stages & treatment

Macular hole stages

Macular holes can increase in size over time if untreated. There are different stages to a macular hole:

  1. Foveal detachment (stage 1 hole) – the fovea is a small cavity in the centre of the macula that’s responsible for sharp central vision. About 50% of these holes progress into a full-thickness macular hole
  2. Full thickness macular hole – they vary from stage 2 to 4, depending on the size and stage of evolution of the hole

Treatment

Vitrectomy surgery is the treatment of choice for a macular hole, and is done under local anaesthesia with sedation. This surgery removes the vitreous gel from the eye and a bubble of gas is placed in the eye, which helps the macular hole heal. Face-down posturing for approximately 3 days after surgery may be required, depending on the size of the hole.

Read our vitrectomy page for further details about what happens during and after surgery.

Is the timing of vitrectomy surgery for macular hole important?

Yes! Scientific evidence indicates that patients achieve better vision if surgery is done within 3 weeks of the onset of visual symptoms.

Can my other eye be affected?

Possibly. If the vitreous gel in the other eye has not fully spontaneously separated from the macula, there is about a 20% chance of a macular hole developing over the next 5 years.

What to expect after macular hole treatment

After vitrectomy surgery, your eye is covered with a gauze pad and a clear plastic eye shield. You can return home the same day and usually within the hour. Your eye will feel numb for a few hours after the treatment.

You can remove the eye shield and gauze pad the next morning, after which you can start using your prescribed eye drops, usually for 4 weeks. The eye shield should be worn at night for 1 week.

Your surgeon will provide details on posturing, which involves how to position your head during the day and/or night to help your macula heal. Posturing is often required for 3 days.

As a gas bubble would have been used during the treatment, your vision will be blurry for at least a week. Your eye will also be red for a few weeks, and can feel dry, gritty and sore for a few days. Make sure you do not take a flight or travel to high altitudes while the gas bubble is in your eye, which can take 3 or more weeks; the higher altitude will cause the gas to expand which can lead to irreversible vision loss.

Recovery from macular hole treatment

In terms of visual recovery, the degree of improvement in vision depends primarily on how quickly surgery is done and the size of the hole. The amount of improvement can vary. Some central visual distortion often remains.

Our Retinal Treatment Testimonials

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If you have any questions around macular hole or our service, please feel free to make an enquiry or call us on 0203 369 2020