Macular Hole
A macular hole is a term for a break or gap that develops in the very central part of the retina. This section focuses on what is called a full-thickness hole, when this gap extends through all of the layers of the retina.
Risk Factors, Causes & Symptoms
Causes
The vitreous is the gel that fills the back portion of the eye. When we are young, that gel is firmly attached to the retina and macula (central portion of the retina). As we age, the gel naturally separates from the macula. In most cases, this happens without any disruption in vision. However, in some patients, the vitreous gel is particularly sticky, and as it separates from the retina, it pulls on the macula and creates a hole in the center of the retina. We do not fully understand why some people develop macular holes and others do not. There is no effective way to prevent a macular hole from forming.
Symptoms
The symptoms of a macular hole include central vision loss and distortion. If a patient with a macular hole tries to read, they may notice the letters are distorted or that parts of the letters are missing.
Testing
The gold standard method of detecting a macular hole is through an imaging test called optical coherence tomography (OCT). With this non-invasive device, a cross-sectional image of the retina can be obtained to determine whether a macular hole is present, and the best treatment plan. It is often required to have this test done at every visit to monitor the success of the treatment, and because the test uses light rays and not radiation, it is completely safe to be repeated as often as needed.
Treatment
Pars plana vitrectomy is the most common and effective treatment for macular holes. During this procedure, the vitreous gel is removed to prevent it from pulling on the retina, and a gas bubble is inserted into the eye to gently hold the edges of the macular hole together while it heals. While this gas bubble is in place (typically between 3-8 weeks), it blocks the vision in that eye, and you are unable to fly in an airplane. In some cases, patients must remain in a face-down position for several days to increase the success rate of the surgery. The need for, and duration of, face-down positioning depends on the characteristics and size of the macular hole. Vitrectomy has a success rate of over 90%, with patients regaining some or most of their lost vision. It is very typical to have some degree of permanent distortion in the vision following successful repair of a macular hole.
Schedule a Consultation for Macular Holes
At Mid Atlantic Retina Specialists, our team of experienced retina specialists can diagnose and treat a wide variety of retinal conditions, including macular holes. Request an appointment today at one of our retina centers in Hagerstown, MD, Frederick, MD, Chambersburg, PA, or Bedford, PA.
