What is a Macular Hole?
Macular hole is a small, circular break in the macula.
What causes Macular Hole?
Shrinking of the vitreous, a jelly-like substance in the back of the eye, usually is the cause of a macular hole. As a person ages, the vitreous becomes watery and begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result.
What are the Symptoms?
Macular holes often begin gradually but can be sudden. 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.
What are the Treatment Options?
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. A thin membrane over the macula is also removed to allow the cells to migrate in to seal the hole. 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.