What You Should Know About Macular Holes

The macula is a small part of your retina that helps you see color and fine details. A macular hole, which is a tear in this tiny area of your eye, can affect your central vision, resulting in blurriness, distortion, and straight lines appearing wavy.

It can be scary when your vision becomes impaired, especially if you’re older. You may fear the worst of outcomes, but fortunately, at University Retina we can treat and repair macular holes.

Macular hole causes and symptoms

Macular holes occur when the vitreous, a jelly-like substance that fills your eye, shrinks. Vitreous shrinkage happens as you get older. When the vitreous shrinks, it sometimes pulls the retina, which can result in a macular tear or hole. The vitreous has fibers that attach to the retina, so when the vitreous shrinks, these fibers can sometimes hold onto the macula and subsequently tear it.  

Fluid fills the space that the vitreous gel-like substance occupied in the eye so that the eye continues to hold its shape. This fluid then seeps through the tear in the macula and results in blurry vision.

Symptoms come on gradually, so you may not even notice them at first. In addition to blurriness, other symptoms of macular holes include:

• Central vision distortion
• Lines look wavy or bent
• A dark spot on your central vision
• Difficulty reading and doing other visual tasks

Macular hole risks

Macular holes are more common in women over 60, but they do affect men. Other risk factors include:

• High myopia (nearsightedness)
• An injury to the eye
• Retinal detachment
• Diabetes
• Macular pucker
• Uveitis (inflammation in the eye)

Once you’ve had a macular hole in one eye, you have a higher chance of getting one in the other eye.

Macular hole diagnosis and stages

If you notice a change in your vision, see an eye doctor right away. At University Retina, we can diagnose a macular hole with optical coherence tomography (OCT). This non-invasive imaging device provides a high-resolution image of your macula.

The earlier we catch a macular hole, the more likely it will be smaller and the easier to treat. In some cases, the holes resolve without treatment, but in most cases, the longer it goes untreated, the more advanced and vision-threatening a macular hole can get.

There are three stages of macular holes. They include:

Foveal detachment

The fovea is a tiny depression in the center of the macula. Symptoms of this early stage of macular holes include some blurriness and vision distortion. About half of stage 1 macular holes progress to stage 2 if untreated.

Partial thickness holes

About 70% of stage 2 holes get worse without treatment.

Full thickness holes

If not treated, most of stage 3 holes go on to get even worse, possibly resulting in vision loss.

Macular hole treatment

The most common treatment for a macular hole is a surgery called a vitrectomy. During a vitrectomy, we remove the vitreous gel and replace it with a bubble that contains air and gas. This bubble creates a space so that the macular hole can heal.

While this procedure is very effective, there is a challenging recovery period. You need to lie facedown for a day or two, or more, to keep the bubble in place.

If you’re worried about your vision and you have symptoms that seem to indicate a macular hole, call one of our four University Retina offices for an appointment, or make one online.