Macular Hole

The macula is located in the middle of the retina and gives our eyes the clear, central vision that we need for reading, driving and distinguishing details. A small tear or break in the macula is called a macular hole, and is most commonly caused by the separation or shrinkage of the vitreous (a gel-like substance in the eye) from the retina.

Macular holes often begin gradually and, in the early stages, patients may have a slight distortion or blurriness when they look straight ahead, and objects can appear twisted or wavy. A macular hole usually occurs in three stages: foveal detachments, partial-thickness holes, and full-thickness holes.

A complete eye exam with an ophthalmologist is needed for a correct diagnosis and while there is a small percentage that will heal on their own, the majority of macular holes will worsen without treatment and can threaten a person’s eyesight.  

Risk factors

• Age 60 and over
• History of diabetic eye disease
• High degree of nearsightedness (myopia)
• Previous eye injury
• Macular hole in opposite eye

Macular holes typically are treated with a surgical procedure, called a vitrectomy. During this surgery, the retina specialist removes the eye’s vitreous gel to prevent it from separating from the retina and allowing other eye fluids to leak behind the retina, which can worsen the condition.  

During a vitrectomy, the vitreous is replaced with a bubble mixture of gas and air that puts pressure on the edges of the macular hole, allowing it to heal. In order for the bubble to press against the macula and seal the hole, however, a patient has to remain in a face-down posit ion for several days. Over a period of time, the air and gas bubble is eventually reabsorbed by the eye and the vitreous cavity will refill with natural eye fluid.