The macula is the central area of the retina, which is responsible for detailed vision. Sometimes, due to tension across the surface, a hole can develop. If there is a hole, there will be loss of visual acuity (ability to see fine detail) and a central scotoma, which is a patch of missing vision. Typically vision drops markedly. The condition affects people in middle age and is more common in women. Most commonly it is idiopathic, meaning that there is no known precipitating factor. An injury to the eye can sometimes cause holes. There is an approximately 10% chance of macular holes ultimately affecting both eyes. Sometimes they occur in high myopia (very short-sighted individuals), in which case there is a risk of retinal detachment.
A full thickness macular hole – stage 4
There are other variants of macular hole:
- Impending hole – stage 1a
- Occult hole – stage 1b
- Partial hole – stage 2-3
- Pseudo-hole
- Lamellar hole
All of these variants produce milder symptoms than full thickness holes.
Photo and scan montage of macular hole.
Investigations
- Fundus photos (back of the eye pics)
- Fluorescein angiography
- OCT scan
Treatment
The quicker the intervention, the better the result. The jelly is removed from the back of the eye (vitrectomy) and any membrane peeled from the macula. A gas bubble is then placed in the eye. You will have to posture face down for a period (usually around a week) in order to keep the gas bubble forcing the hole closed. Generally results are good, although not perfect, if the hole is closed early. The prognosis is not so good for holes that have been left for more than a year.
Monitoring
You can use an Amsler chart to monitor for distortion. If there is a sudden onset, you should see your ophthalmologist as soon as possible. This can be downloaded from the following site and printed off:http://www.macular.org/pdf/amsler.pdf
This shows the hole after the
inner membrane of the retina has
been peeled off and the vitreous
jelly has been removed.
A gas bubble will be left in the
eye to keep the hole closed.
An OCT scan of the macula before and after surgery
