A Macular Hole is a small central break in the macula tissue of the retina at the back of the eye. The macula is the region of the retina responsible for sharp, central vision. It is dense with light-sensing cells which help us fine tune our vision for reading, recognizing faces, and driving. The size of the hole and its location determine its affect on a person’s vision. If left untreated, a Macular Hole can lead to severe vision loss, including a possible retinal detachment.
Most of the eye’s interior is filled by the vitreous – a gel-like substance that fills the back chamber of the eye. The vitreous is attached to the retina by millions of fine fibers, but as we age, these fibers begin to shrink and pull away from the retina. Eventually, if enough fibers separate it can cause a complete posterior vitreous detachment (PVD). When a PVD occurs, individuals may experience a sudden increase in Floaters. Floaters are harmless little specks that float about in your field of vision. However, if the vitreous is firmly attached to the retina when it pulls away, it can create a Macular Hole. PVD is one potential cause for a macular hole. They can also form due to traction exerted by cellular membrane on the surface of the macula. Once the macular hole is formed, it will cause blurred and distorted central vision. Macular Holes can also occur in other eye disorders, such as high myopia (nearsightedness), injury to the eye, retinal detachment, and macular pucker.
Optical coherence tomography (OCT) is the key diagnostic test to identify a Macular Hole. In some cases, a small Macular Hole may close or heal on its own. Or, a surgical procedure, known as a vitrectomy, may be required to close the hole. During this procedure, your retinal specialist removes some of the vitreous gel and replaces it with a bubble of gas. The bubble helps close the Macular Hole. Patients will be required to maintain a face-down position for a several days after surgery to help the gas bubble exert pressure on the hole which is at the very back of the eye. The gas bubble gradually dissolves over time.