The macula is in the center of the retina, the light-sensitive layer of tissue at the back of the eye. As you read, light is focused onto your macula. There, millions of cells change the light into nerve signals that tell the brain what you are seeing. This is called your central vision. With it, you are able to read, drive, and perform other activities that require fine, sharp, straight-ahead vision.

What is a macular hole?

Macular hole is a full thickness round hole in the macula. It is thought to result from an abnormal side traction on the center of the retina (macula) by the vitreous jell. When this hole forms, the fluid in the eye will go through it and elevate the edges of the hole. The trigger for this problem to occur is unknown. Occasionally, trauma or previous surgery may induce the formation of a macular hole.

Macular hole with surrounding cuff of fluid.
Click image for enlarged view.

What are the symptoms of macular holes?

Patients with macular holes reports seeing a round black circle in the very center of their vision. Very frequently, patients describe objects being tapered in the center like an hourglass. Rarely, retinal detachment may occur in the presence of a long-standing macular hole.

What is the treatment for this condition?

Until recently, no treatment was available for macular holes. Thanks to the improvement in microsurgical technology, macular holes can now be treated by a surgery called vitrectomy. Through the use of microsurgical instruments and under an operating room microscope the vitreous (the jelly that fills up most of the eye volume) is removed and a fine microsurgical forceps is used to grasp and peel any membrane that applies side traction on the retina. The eye is then left full of a special gas that pushes on the retina and helps close the macular hole.

No medical treatment (drops, pills or laser) can be used for this condition.

Are there any special positioning requirements after surgery?

Yes, In order to have its maximal effect, the gas bubble left in the eye must apply continued upward pressure against the treated macular hole. Because the macula is located in the back part of the eye, a patient's head must remain in a facedown position to allow the gas bubble to rise toward the back of the eye and apply that pressure. Patients are asked to maintain this facedown position for approximately 7-10 days after surgery. They are also instructed NOT to sleep on their back for 2-3 weeks after surgery.

Is the surgery still an option if I had the macular hole for a long time?

Traditionally, Macular holes were treated only if the were less than 6 months old. Any hole older than 6 months was considered poor surgical candidates. Currently, there is scientific evidence in the ophthalmic literature that report good results after surgery for long-standing macular holes. The advancement in microsurgical techniques has opened the door for treatment of a condition that was considered untreatable just few years ago.

How much vision improvement should one expect after having surgery and how fast?

During the first 2-3 weeks after surgery, the gas bubble will occupy most of the eye volume. The eye cannot focus well through gas which will make seeing out of it very difficult. In the first few days after surgery, patients should expect to only see their hand if they wave it in front of their face. After the first week, the eye begins to absorb the gas and replace it with fluid it produces. During this period the gas bubble will become smaller and smaller and patients report an "under water" feeling when the gas is about 50% of it's original size. When the gas bubble becomes small enough to be away from the macula, vision will start to improve. On average, patients should expect about a 3-line improvement in vision after this kind of surgery.

Is there any medication (drops) or nutritional supplement that can treat or "dissolve" this scar tissue?

Unfortunately, there is no known medication, laser treatment or nutritional supplements that can be given to treat macular holes. Surgical treatment is the only treatment available for this condition.

How long do I have to be in the hospital for this surgery and what kind of restrictions should I expect?

In most cases, the surgery will be a "same day surgery". This means that patients will be discharged home few hours after surgery. Occasionally, patients are kept overnight for observation. There are very few restrictions after surgery. Bending down and lifting objects heavier than 10 lbs are discouraged.

Can I travel by airplane after the surgery?

No, The changes in atmospheric pressure that occur during take off and landing can significantly alter the size of the gas bubble in the eye which may result in severe glaucoma. Air travel should be delayed until the gas bubble is almost gone. Travel by ground is permitted.

Are macular holes and macular degeneration related?

Macular degeneration is not related to macular holes except that they both can cause distortion in central vision. The distortion caused by macular degeneration is typically permanent and cannot be treated by surgery. Macular hole is a true full-thickness defect in the macula that result from side traction on the center of the retina.

If I don't have surgery for macular hole, will I continue to lose vision until I'm blind?

Typically, Patients with macular hole will have an acute loss of central vision and then remain steady after that. Rarely, retinal detachment may occur in the presence of a long-standing macular hole which may result in total loss of vision. With very long-standing holes, surgical success rate decreases and the vision loss may remain permanent despite successful closer.

If I have a macular hole in one eye, what is the chance I could get it in the other eye?

The possibility of a macular hole in the other eye depends on the traction exerted by the vitreous jell on the macula. A careful examination by your ophthalmologist should help determine your risk.