Macula Hole : Cause, Symptoms, Treatment, Diagnosis

A macular hole is a defect that involves the full thickness of the foveal retina from the internal limiting membrane to the outer segment of the photoreceptor. In it, the nerve cells of the macula get separated from each other and pull away from the back surface, which affects the vision. It can be partial or complete.

A macular hole is a potential cause of blurred vision. However, it’s not a very common condition.⁽¹⁾ A macular hole is known to affect 7.8 people per 100, 000 people per year.⁽²⁾

A healthy macula is important for driving, reading, and performing precise tasks. If there is any abnormal change in the macula, there is an immediate loss of central vision. For example, in eye disease related to diabetes, unwanted fluid accumulated in the macula causes macula edema. In macular hole layers of macula separate and tear.

Age is the most common cause of macular holes. As a person ages, the vitreous naturally begins to pull away from the retina. This is normal. But, sometimes the vitreous sticks to the retina, which can cause the macula to stretch and a hole to form.

Macular holes can also occur after an eye injury or an eye disease.

A person is more likely to develop a macula hole in the following conditions:

• Being over 60 years of age
• Being nearsighted
• Those who have had eye surgery or eye injury

Also, the chances of a macula hole increase if a person has it in one eye. Research shows that 1 in 10 people have a macula hole in one eye and get it in other too.⁽³⁾

The primary symptom of a macular hole includes blurry or wavy vision. This is observed while driving a car or reading. It occur more in people with good eyesight in the other eye.

The person may observe similar distortions while looking at the tiled wall of the bathroom.

There is a loss of central vision as the hole progresses. A macular hole does not affect the peripheral vision. This means viewing a person’s face may be possible not the nose and eyes.

An ophthalmologist starts the diagnosis of a macula hole by putting in drops in the eye to dilate the pupil. As the eye gets dilated the doctor takes pictures with optical coherence tomography. This machine takes pictures of the retina and macula painlessly. It is a safe technique and the imaging does not rely on ionizing radiations.

It is important to keep a check on the small holes so that they do not get worse.

The macular holes can get healed without any intervention. Most cases require surgery. The surgery for the macular hole is known as vitrectomy. It involves removing the vitreous that is pulling on the macula. After the completion of the surgery, a gas bubble is placed inside the eye to flatten the macular hole so that it is held in place during the healing process. The bubble placed in the eye goes away on its own.

It may take the eye several days to heal. The improvement in vision may depend on the size of the hole and the time taken by it to heal.

After the surgery for macular hole, there are certain precautions that a person needs to take including:

• No flying or driving as the air is still in the eye post-surgery
• To limit dental procedures involving nitrous oxide gas, while there is gas in the eye after surgery
• Avoiding bending or lifting for at least 1-week post-surgery
• Avoiding soap and water in the eye while washing the face or taking a shower
• It is important to wear sunglasses and use eye patches and eye drops post surgery.

Macular holes can affect the central vision and make it difficult to perform daily tasks like reading and driving. It is important to get any eye condition checked by an ophthalmology to get an early diagnosis and treatment for it.