Macular hole
A macular hole is a condition in which an opening forms in the macula - the central part of the retina responsible for clear and precise vision.
The macula enables us to read, recognise faces, and notice fine detail. When a hole forms, central vision becomes blurry or disappears.
How does it develop?
The most common cause is the natural ageing of the eye. Over time, changes occur in the vitreous - the gel-like substance inside the eye - which may pull on the macula and cause damage.
The vitreous is a gelatinous substance that fills the interior of the eye and gives it its shape. It sits behind the lens and extends to the retina, to which it is attached at certain points. With age, the vitreous contracts - and if there are attachments in the macular area, traction occurs - the vitreous pulls on the macula.
Under the influence of centrifugal force, the surface layer of the retina can tear and detach, forming a "hole" in the macula. Fluid enters through the opening in the retina, lifts the macula, and causes swelling (oedema).
A macular hole may also develop as a result of:
What are the symptoms?
Symptoms usually develop gradually:
blurry central vision
distorted vision (straight lines appear wavy)
a dark or empty spot in the centre of vision
difficulty reading
In the early stages, symptoms are usually discovered by chance - when the healthy eye is covered. A macular hole very rarely occurs in both eyes, so many holes go undetected for a long time.
Peripheral vision usually remains intact.
How is it diagnosed?
Diagnosis is made through an ophthalmological examination:
OCT provides a precise view of the size and stage of the hole - and can detect even very small changes that cannot be seen during examination.
How is a macular hole treated?
A macular hole is treated solely through surgery - vitrectomy.
During the operation:
part of the vitreous pulling on the macula is removed - releasing the traction
a mixture of gas and air in the form of a bubble is injected into the vitreous space
the macula is relieved of pressure, enabling the hole to close through healing
What are the results?
The success of surgery depends on the stage of the hole and the time elapsed before treatment. The earlier the diagnosis is made and surgery is performed, the greater the chance of vision improvement.
Success also depends on following post-operative recovery instructions. Face-down positioning is often required during recovery - which can last several weeks - so that the gas bubble presses against the hole and enables it to close.
People who have had a macular hole in one eye have a higher chance (around 10%) of developing a macular hole in the other eye at some point in their life. Regular check-ups are therefore very important - to detect the problem early and prevent greater damage.
Frequently asked questions
Can a macular hole heal without surgery?
In very rare cases, with the smallest holes in the first stage, spontaneous closure is possible. However, this is the exception, not the rule. In the vast majority of cases, a macular hole requires surgical treatment.
Can a macular hole be caused by a blow to the eye or physical exertion?
Direct trauma to the eye (a blow to the eye or head) can cause a macular hole and is a known risk factor. Physical exertion such as weightlifting is generally not a direct cause. However, people with high myopia or pre-existing changes in the eye should consult an ophthalmologist before intense physical training.
Noticed a dark spot in the centre of your vision?
Do not wait for symptoms to worsen - with a macular hole, time directly affects the treatment outcome.