What is it?
A macular hole is a small break in the macula, the central part of the retina responsible for sharp, detailed vision. Most macular holes develop as the vitreous gel changes with age and pulls on the centre of the retina.
Symptoms
Symptoms usually develop gradually and include blurred central vision, distortion (straight lines looking bent) and difficulty reading. In later stages a small dark or missing area may appear in the centre of vision.
Possible causes
Most macular holes are related to the vitreous gel pulling on the macula as it separates with age (vitreomacular traction). Less commonly they follow eye injury, high myopia or other retinal conditions.
Risk factors
Macular holes are more common after the age of 60 and occur more often in women. Having a macular hole in one eye increases the risk in the other eye.
Diagnosis
Optical coherence tomography (OCT) is the key test. It confirms the diagnosis, measures the size of the hole and helps with treatment planning.
Treatment options
Full-thickness macular holes are usually treated with vitrectomy. The vitreous gel is removed, the thin inner layer of the retina (internal limiting membrane) is often peeled, and a gas bubble is placed in the eye to support closure. Some small holes associated with traction may close on their own and can be observed first.
When urgent evaluation may be needed
A macular hole is usually not an emergency, but new central blurring or distortion should be assessed promptly to rule out conditions that need urgent treatment.
Follow-up
After surgery, head positioning may be recommended for a period. Flying or travelling to high altitude must be avoided while gas remains in the eye. Vision can continue to improve for several months after successful closure.
Information on this website is educational and does not replace an in-person medical examination, diagnosis or individual medical advice.