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Macular Hole

A macular hole effects the vision in the center of the retina, known as the macula. The retina is the neurosensory tissue of the eye that transmits the optical images we see into the electrical images our brain understands.

The fovea is the center of the macula and is the most central part of our vision, where the majority of photoreceptor cells are located. The macula is responsible for tasks such as reading, watching TV, and driving. Macular holes are most prevalent in people over the age of 60. Macular holes are a degenerative process and are often spontaneous in nature.

Macular hole symptoms may include blurriness, distortion, or a grey/dark spot in a patient’s central vision, depending on the severity of the macular hole. Straight lines may also appear bent or distorted.

What causes a macular hole?

About 80% of the eye is filled with vitreous humor. The vitreous humor is made up of mostly water, yet it has a firm, jelly-like consistency. The vitreous helps to hold the spherical shape of the eye and keep the retina in place. As we age, the vitreous starts to liquify and partially detach from the retina causing the vitreous to partially or completely detach from the retina. The proteins and collagens in the vitreous also start to thin over time. This is normal and rarely effects vision other than causing small shadows or floaters. This process is most often documented as a partial or complete posterior vitreous detachment.

Sometimes, the vitreous detachment can cause microscopic changes in the integrity of the retina. When the vitreous separates, it may cause wrinkling of the retina known as an epiretinal membrane or macular pucker, or a macular hole. A macular hole rarely leads to a retinal detachment, although it may lead to central vision loss, depending the stage of the macular hole.


Macular Hole (Video)


What are the stages of a macular hole?

1. Stage one macular hole – small foveal detachments with a partial-thickness defect. In stage one, about half of macular holes may progress, without treatment.



2. Stage two macular hole – small full thickness hole/s. In stage two, about 70% of macular holes will progress without treatment.



3. Stage three macular hole – larger full-thickness hole/s without separation from the vitreous, although adhesions or partial attachments to the vitreous are present.



4. Stage four macular hole – larger full-thickness hole/s with separation from the vitreous.

What can I expect during a visit to evaluate a macular hole?

After a comprehensive, dilated eye examination is performed by your ophthalmologist, a series of diagnostic tests may be ordered to better evaluate the health of your retina. The tests include, but are not limited to:

  • Fundus Photography
  • Optical Coherence Tomography (OCT)
  • Optical Coherence Tomography Angiography (OCT-A)
  • Intravenous Fluorescein Angiography (IVFA)

Along with a comprehensive eye examination and visual acuity testing, diagnostic imaging directly corelates in the assistance of each patient’s individual plan of care. Utilization of all forms of examination will help your physician to better evaluate your specific retinal needs, in addition to aid in the evaluation of the stage of a macular hole. Your physician may advise to either monitor your eye or suggest surgical intervention in order to best preserve your vision.