What is a macular hole?
Macular hole means there is a tiny hole in the center of the retina. The retina is a thin layer of tissue in the back of your eye which lines the inside wall like the film inside the back of a camera. The retina “takes a picture” of objects you look at and sends it to the brain. The macula is the center of the retina and gives you sharp central vision for reading and seeing fine details. When the macula is damaged, the central vision worsens. Macular hole is not macular degeneration and does not lead to macular degeneration. Macular hole affects both eyes in only about 10% of cases.
What causes a macular hole?
A macular hole is caused when the clear gel that fills the eye (vitreous) pulls on the macula. When you are born the vitreous gel is thick, clear, and filled with tiny, invisible fibers. With age or trauma, the vitreous gel begins to condense and pull away from the retina. If the attachment of the vitreous to the macula is unusually strong, the pulling may result in a macular hole.
What are the symptoms of a macular hole?
Blurring of vision is mild at first, noted especially while trying to read fine print. It slowly worsens; often with distortion (straight lines look crooked). Sometimes there is a small blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.
What treatment is available?
In a small number of cases, a macular hole may heal itself. In other cases the vision improves with a medicine injection (Jetrea®). If this fails or is not possible, a surgery may be performed that releases the abnormal pulling of the vitreous on the macula. A gas bubble (pneumatic retinopexy) is then placed in the eye to close the hole in the macula. Strict facedown positioning is recommended for several days following surgery. Special cushions and massage tables are available to help maintain the proper head position. The most common side effect of surgery is cataract formation. Cataracts develop after surgery in most eyes over several months to years. About 5% of eyes require more than one surgery to close the macular hole. In 2-3% of eyes, the retina may detach during or soon after surgery as a result of continued pulling on the retina by vitreous fibers. This requires additional surgery to prevent profound loss of vision. Unommon risks of surgery include hemorrhage, infection, blindness and loss of the eye.
Surgery to close macular hole is usually successful in improving vision, though the vision rarely returns completely to normal. Some residual distortion and central blurring of vision is common. The vision improves very slowly after surgery over several months to years.
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