A macular hole is the formation of an opening in the macula, the central area of the retina responsible for detailed central vision. These breaks typically occur as a result of the macula being stretched or pulled. Changes in the eye generally happen with natural ageing.
As the macula ages, the vitreous (the transparent gel that fills the space between the lens and the retina) can shrink, pulling on the macula and causing a tear or opening. Fluid can enter this tear, resulting in blurred or distorted vision. The macular hole can grow larger over time, resulting in increased vision complications. For this reason, while some may experience mild symptoms, in some cases, surgery may be considered to reduce the risk of further vision impairment.
A macular hole usually only occurs in one eye; however, the other eye has a 15-20% probability of also incurring this condition.
Two types of macular holes can occur: primary and secondary. Primary macular holes are the cause of natural degeneration, while secondary macular holes are the result of another disease, condition, or physical trauma.
Symptoms
Macular holes directly affect central vision, and the severity of its impact depends on the stage of the hole's development. Initially, a small tear in the macula will cause blurred and distorted vision. Straight lines may appear wavy, or reading small print may be troublesome. As the macular hole develops, the number of floaters (small moving strands within the vision) may increase, and eventually a blind spot can form in the centre of your line of sight.
Symptoms do have multiple alignments with other conditions, such as age-related macular degeneration (AMD), but they're different.
People with a high degree of near-sightedness (myopia), uveitis (eye inflammation), or eye trauma are more likely to develop a macular hole.
Treatment
The most effective treatment for a macular hole is usually a surgical procedure called a vitrectomy. In a vitrectomy, the surgeon extracts the vitreous and certain surrounding tissues from the macula's surface, then injects a gas bubble into the eye. This bubble acts as a temporary bandage, securing the edges of the macular hole and aiding in the closure of the opening. Outcomes may be better if the vitrectomy is performed earlier in the macular hole’s development. Possible complications of this treatment can include infection, bleeding, optical nerve damage (glaucoma), retinal detachment, and a reopening of the macular hole... or it never closes.
It is recommended to book an appointment if you are experiencing any of the symptoms listed above.
How to prepare for Macular Hole treatment
Preparing for macular hole treatment involves consulting with your retina specialist, providing a medical history, and undergoing diagnostic tests such as an OCT. Discuss the available treatment options, such as vitrectomy, with your doctor and ask questions to address any concerns you may have. Arrange transportation for the day of surgery and follow all preoperative instructions, including fasting and the use of eye drops.
Plan for postoperative care by securing assistance at home and adhering to prescribed medications and activity restrictions. Attend follow-up appointments as directed and be aware of the expected recovery time and potential changes to your vision during the healing process. Always consult with your eye care professional for personalised guidance based on your specific situation.
Recovery from Macular Hole treatment
After macular hole treatment, focus on a smooth recovery by following your eye care specialist's guidance. Adhere to prescribed medications, especially eye drops, and carefully follow postoperative instructions, including activity restrictions. Plan for temporary vision changes and arrange for assistance at home during the initial recovery phase.
Attend scheduled follow-up appointments to monitor progress and address any concerns. Prioritise rest and avoid activities that may strain the eyes. It's essential to be patient during the recovery process, as healing times can vary. Communicate any unexpected symptoms or changes in vision promptly to your healthcare provider.
Medical Disclaimer
This article is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment, and does not establish a doctor-patient relationship. All medical procedures carry risks, and outcomes vary between individuals. Always seek the advice of your GP, specialist, or another appropriately qualified health professional with any questions you may have regarding a medical condition or treatment. Where further or specialised care is required, your treating practitioner can provide an appropriate referral.
