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Eye Conditions and Diseases

Macular Hole

Dilated eye exam and optical coherence tomography (pictures of the retina)
Close observation for small holes, surgery for most cases
A macular hole is a rare eye condition that can blur the central vision you use to do everyday tasks like driving or reading.
The macula is a small area in the center of the retina (the light-sensitive layer of tissue in the back of the eye). Macular holes happen when an opening forms in the macula — usually after being stretched or pulled. Most macular holes form because of changes in the eye that happen as you age.
Some people with macular holes have mild symptoms and may not need treatment right away. But doctors may recommend surgery to protect your vision if a macular hole is getting bigger, getting worse, or causing serious vision problems.
If your other eye has good vision, you may not notice any symptoms from a macular hole. When a macular hole does cause symptoms, they often start slowly.
At first, you might notice that things look distorted or blurry when you look straight ahead. Lines or straight objects — like a window frame — might look bent, wavy, or like they’re missing a piece in the center. It might be harder to do everyday tasks like reading, writing, or driving.
Over time, you might notice a blurred or blind spot in your central vision. When reading, you may see the lines but miss letters or words in the center. Or you may be able to see a person’s face but not their nose or eyes.
Early treatment with surgery can often restore vision. Without early treatment, central vision loss may be permanent.
No. Macular holes and age-related macular degeneration can cause similar symptoms and they’re both common in people over age 60, but they're different. If you aren't sure which condition you have, talk to your eye doctor.
If you’ve had a macular hole in 1 eye, you’re more likely to develop it in the other eye. About 1 in 10 people who get a macular hole in 1 eye will develop a macular hole in their other eye.
You’re also at risk for a macular hole if you:
Most of the time, a macular hole happens because of changes in your eye as you get older.
As you age, the vitreous (the clear gel-like fluid that fills your eye and gives it a round shape) shrinks and pulls away from the retina. This is called vitreous detachment , and it happens to everyone as they get older.
In some people, the vitreous is attached more firmly to the macula and it pulls on the macula as it detaches. This pulling and stretching of the retina can cause a macular hole.
Your eye doctor will check for a macular hole by doing a test called an optical coherence tomography (OCT). This is a painless test that uses light waves to take detailed pictures of your retina.
Before the test, your doctor may give you some eye drops to dilate (widen) your pupil.
If a macular hole is affecting your vision, you’ll probably need a type of surgery called vitrectomy to fix the hole and prevent permanent vision loss.
During a vitrectomy, the doctor removes the vitreous and some tissues on the surface of the macula and injects a gas bubble into your eye. The bubble is like a temporary bandage that holds the edges of the macular hole together and helps your eye close the hole.
After the surgery, you’ll need to limit your activities and movement for a while. This keeps the bubble in the right place so the macular hole can heal. It can be hard to limit your head movement, so talk to your doctor about how you can best recover from a vitrectomy. You also need to avoid flying or getting nitrous oxide (laughing gas) for any procedures until the bubble is completely gone — these things can affect the pressure in your eye.
Treatment works best when doctors catch macular holes early, so it’s important to talk to your eye doctor right away if you notice symptoms of a macular hole.

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