Background

Macular holes are a common diagnosis which occurs when a full thickness break occurs in the center of the macula, which is the area in the center of the retina associated with your central vision. Patients may notice blurry central vision in the affected eye. Straight lines may appear wavy, or patients may notice a dim or gray area in their central vision. These most commonly occur in patients over the age of 55.

OCT image of a full thickness macular hole, with evidence of vitreomacular traction to the inner retina.

The most common cause of macular hole is traction associated with the vitreous gel pulling away from the retina as part of the normal aging process. Other predisposing risk factors include trauma to the eye, diabetes, inflammatory diseases, a high degree of nearsightedness, and the presence of membranes or scar tissue over the surface of the retina.

Diagnosis

Clinical Exam

Your doctor will do a complete eye exam including a dilated examination to look for any associated retinal pathology such as scar tissue or retinal tears.

Testing

Your doctor may order optical coherence tomography (OCT) scans to help diagnose, stage, and manage this disease. This imaging provides your doctor with cross sectional images of your retina and can be very useful in creating a treatment plan.

Management

Your doctor will discuss the risks, benefits, and alternatives of the various treatment options. The most common treatment for macular holes is vitrectomy surgery. In this surgery, the vitreous gel is removed from the eye. Often times, a gas bubble is placed in the eye to help close the hole. Patients often are asked to keep their head positioned face down for a period of time after surgery depending on the characteristics of their condition. Other potential options for treatment include injection of an enzyme to attempt to break up the vitreous gel, or your doctor may recommend watchful waiting without any initial treatment if your macular hole meets certain criteria.

Conclusion

Macular holes can cause a significant amount of vision loss. Many retinal holes can be observed with routine monitoring exams, while others require treatment. Your doctor will review your condition with you and recommend observation or treatment depending on their findings.