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Macular Hole

A macular hole is a break in the macula, a small area in the retina which is responsible for sharp, central vision and color vision. Macular holes are associated with aging and usually occur in individuals over 60 years of age.

What Are the Symptoms of a Macular Hole?

Macular holes often develop gradually, so symptoms can very depending on the severity of the condition. Early on in the development of a macular hole, symptoms may be slight of non-existent.

Common symptoms include:

  • A slight distortion or blurring in central vision
  • Straight lines and objects appearing bent or wavy
  • Reduced vision when viewing objects at a distance and near
  • Difficulty reading or performing fine tasks

What Is a Macular Hole?

A macular hole is a disruption of the macula, found in the center area of the retina. As we age, the vitreous fluid, which fills approximately 80% of the interior of the eye, begins to shrink and pull away from the surface of the retina. The separation of vitreous fluid usually results in harmless floaters. In some cases, however, the vitreous is firmly attached to the retina when it pulls away and creates a tear in the retina resulting in a macular hole.

Are There Different Types of Macular Holes?

Yes. Macular holes develop over time and there are three marked stages in this development.

  • Foveal detachments (Stage I): In 50% of cases this hole will worsen without treatment.
  • Partial-thickness holes (Stage II): In about 70% cases, Stage II macular holes will worsen without treatment.
  • Full-thickness holes (Stage III): When a macular hole has progressed to Stage III, it is likely that most central vision will be lost. If left untreated a Stage III macular hole can lead to a retinal detachment, which will require immediate action to prevent total vision loss.

How Is a Macular Hole Treated?

Although some macular holes may close on its own and require no surgery, surgical intervention is often required to correct the problem and improve vision. Macular holes are repaired through a surgical procedure called a vitrectomy. During a vitrectomy, the vitreous fluid is removed to prevent further pulling on the retina and is replaced with a bubble containing a mixture of air and gas. The bubble acts as a temporary bandage inside the eye to hold the edge of the macular hole in place as it heals. The surgery is performed under local anesthesia and is usually outpatient. After surgery, the patient must remain in a face-down position for several days to ensure that the bubble remains in position and is reabsorbed into the eye, sealing the hole. The majority of macular holes can be successfully repaired and vision often is improved. Vision improvement is more likely in patients that have had a macular hole for less than six months than in those that have had the condition for a longer period of time. A vitrectomy is performed by an ophthalmologist specializing in the retina. Your ophthalmologist can refer you to a retina specialist if surgery is required to treat your macular hole.

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