A hole in the macula, the tiny oval area made up of millions
of nerve cells located at the center of the retina responsible for sharp, central
vision.
T he eye contains a jelly-like substance called the vitreous. Shrinking of the
vitreous usually causes the hole. As a person ages, the vitreous becomes thicker
and stringier and begins to pull away from the retina. If the vitreous is firmly
attached to the retina when it pulls away, a hole can result.
The size of the hole and its location on the retina determine how much it affects
vision. Generally, people notice a slight distortion or reduction in their eyesight.
However, if the hole goes all the way through the macula, you can lose a lot of
your central vision and therefore your detailed fine vision.
A surgical procedure called vitrectomy is often used to treat holes that go all
the way through the macula. The vitreous is removed to prevent it from pulling on
the retina. It is replaced with a gas bubble that eventually fills with natural
fluids. Following surgery, patients must usually keep their faces down for two or
three weeks. This position allows the bubble to press against the macula and seal
the hole.
Vitrectomy can lead to complications, most commonly an increase in how fast cataracts
develop. Other less common complications include infection and retinal detachment
during surgery or afterwards.
Vitrectomy is about 90% effective in closing the hole. However, improvement in
people's vision is more variable. More than half of those who have the surgery can
expect an improvement of two lines or more on the vision chart.
Very few people get a macular hole in the second eye. A macular hole may also
be called a macular cyst, retinal hole, retinal tear, or retinal perforation.
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