OCT Scan showing a hole in the macular.
What is a macular hole?
The macula is a small area in the centre of the back of the eye where light focuses allowing us to see colour and sharp images. A macular hole is a hole in the middle of the macula that affects central vision and can impact our ability to read, drive and see fine detail.
Whilst the exact cause is unclear, it is considered to be associated with posterior vitreous detachment (PVD). With normal PVD, the vitreous detaches cleanly from the macula resulting in no damage, however, in some instances it can retain a strong hold pulling the fovea (central part of macular) creating a hole in the centre of the macula.
Macular holes can also be associated with diabetic eye disease, macular pucker, being near sighted (myopia), and as a result of an eye injury.
What are the symptoms of a macular hole?It can be rather frightening if the vision in one or both of your eyes suddenly becomes blurry and distorted. These are two of the more common symptoms associated with the presence of a macular hole. Furthermore, as the hole grows, central vision can be further impaired as a dark spot will appear. Side or peripheral vision is not impacted.
Who is at risk of macular hole?
Macular holes tend to present themselves as we age and are more commonly occurs in women. Those over the age of 60 are more likely to develop this condition because the vitreous gel-like substance that naturally exists inside the eye shrinks as we age (PVD) and if attached to the macular can be the trigger for a macular hole to generate.
How are macular holes treated?
The most common treatment for macular hole is vitrectomy surgery. Vitrectomy is a surgical procedure performed by an ophthalmologist (an eye doctor) where the vitreous that is causing the trouble is removed and a gas bubble is inserted into the space as a replacement. The bubble helps to close the macular hole and over time gas bubble disappears as the eye heals.
Whilst a small proportion of very small macular holes can and do, in their early stages, close on their own, by the time the symptoms have been recognized, the size of the macular hole is inevitably past this point and vitrectomy surgery is the best option to close the macular hole and improve vision. It is important to note that if left alone without vitrectomy surgery, macular holes do not cause blindness.
Not for the faint hearted, this video shows Dr. Park from Westside Eye Clinic performing macular eye surgery.