Macular Hole

A macular hole is where a hole has developed in the macula. The macula is where you see fine detail and colour; the macula is the central part of the retina, your central vision. The retina is the light sensitive layer that allows you to see and is situated at the back of the eye. A macular hole would not cause total blindness but would affect your central vision. A macular hole will often start gradually and can get worse. The size and location of the hole will determine how badly the vision is affected.

There are 3 stages to a macula hole

• Stage 1, foveal detachments is when the most central point of your vision, the fovea detaches

• Stage 2, partial thickness holes

• Stage 3, full thickness holes, can cause the most loss to your central vision

Untreated macular holes can lead to a detached retina and would require immediate treatment. If one eye has a macula hole there is between 10-15% chance, that at some point a macula hole could occur in the other eye.

• Distortion in your central vision

• Inability to see clearly

• Difficulty in reading

• Difficulty in driving

• Difficulty in seeing detail

• Straight edges appear wavy or distorted

• Using your peripheral or off central vision to see better

• No pain

At the back of our eyes we have a jelly-like substance called the vitreous, the vitreous jelly is made up of many fibers. The vitreous is attached to retina, the light sensitive layer you see with, at various points. One area the vitreous is attached to is the macula, your central vision. As we age, the eyes age too and vitreous jelly slowly comes away from the retina. When the vitreous contracts and pulls away normally, some patients may experience floaters, small black, grey or see through ‘bits, blobs or cobwebs’ floating in their vision. The contracted vitreous leaves an empty space and natural fluids in the eyes then fill up the space.  The contraction and coming away of the vitreous is a normal process and does not usually cause your eyes any harm. It is known as posterior vitreous detachment, PVD.

However, if the vitreous is firmly attached, when it contracts & pulls away from the retina or macula, it can tear the retina or macula. If the tear occurs in the central area of the retina, the macula, this would create a macula hole.

Another cause is if there are vitreous fibers left on the macula after the vitreous has naturally come away; these can contract, cause tension on the macula surface and create a macula hole.

In both cases, a naturally occurring fluid in the eyes would replace the vitreous that has come away. This fluid could enter the macula hole and distort the central vision further.

Macula holes can occur secondary to injuries to the eyes, high myopia or high shortsightedness, diabetes, best’s disease, retinal detachments and macula puckering.

Treatment for a macula hole is surgery; the surgery is called a vitrectomy. Some patients may not require surgery but monitoring of the macula hole if it is small. Some patients may opt not to have treatment if they feel they can rely on the ‘good’ or unaffected eye.

A vitrectomy surgery is used to try and ‘close’ the hole. This can hopefully save most of your vision, 10% of patients may not find any improvement after the surgery.

The vitreous is removed from the eye and then the eye is filled with a bubble of gas. The removal of vitreous stops any further contracting or tension to the retina. The bubble of air & gas is then inserted to ‘seal’ the macula hole and allow the macula hole to heal. The two types of gas that could be used are C3F8 and SF6. C3F8 remains in the eye for up to 12 weeks, the SF6 remains in the eye for 2-3 weeks. The eye will take between 2-3 weeks to heal, however improvement in the vision may continue for several months after. Following the surgery you will be asked to maintain a face down recovery posture, this will keep the gas bubble in situ and allow the macula hole to seal. The eye will eventually absorb the gas. You will be required to attend follow up appointments to assess the healing of the macula hole.

• Cataracts are a common side effect after vitrectomy surgery

• For a few months after surgery it is recommended you do not fly

• If you have any other medical treatment always tell them about the vitrectomy surgery and gas bubble used

• If you have any side effects or post surgery complications you must inform the Ophthalmologist immediately

• Follow your Ophthalmologist’s advice on whether you can drive or not. Notify the DVLA