What is a macular hole?
The macula is the central part of the retina, located at the back of the eye, where light focuses, responsible for sharp central vision and color perception. A macular hole is a small tear or defect in the macula, leading to blurred and distorted central vision. It primarily affects individuals over 60 years old and it is categorized into five stages (0 – 4), based on size and severity. Women are more frequently affected than men.
What causes a macular hole?
Macular holes are most commonly caused by age – related degeneration of the vitreous, the gel – like substance filling the eye. As we age, the vitreous shrinks and pulls away from the retina, sometimes tearing the macula. Less commonly, they may occur in people with high myopia, eye traumas, or chronic eye diseases like diabetic retinopathy.
What are the main symptoms of a macular hole?
Patients usually notice blurred or distorted central vision and, in advanced cases, a dark spot (central scotoma). Color perception is also reduced. In case one eye is affected, symptoms may go unnoticed, due to compensation by the other eye. This is why many cases are discovered during routine ophthalmological examinations. Untreated, a macular hole leads to progressive loss of central vision, leaving only peripheral vision intact.
How is a macular hole treated?
A full – thickness macular hole requires surgery, called posterior vitrectomy. This procedure is performed under local anesthesia and lasts 30 – 40 minutes for an experienced, specialized vitreoretinal surgeon. The surgeon removes the vitreous gel and injects a gas bubble into the eye, which helps seal the hole.
Postoperative instructions and results
Postoperatively, patients must avoid lying on their back for 5 – 7 days and refrain from flying or high – altitude travelling while the gas is present. The gas bubble gradually absorbs and it is replaced by natural eye fluids. Vision remains blurred for at least two weeks, with patients perceiving a large «black ball» in their vision, which shrinks over time. While significant visual improvement is expected, full recovery may take up to 4 -6 months.
Solon Asteriades MD, FRCS
Ophthalmic Surgeon
Specialized in Vitreoretinal and Macular Surgery
[email protected]