Macular Holes: How They Are Formed and Repaired

It can be disturbing if the vision in one of your eyes suddenly becomes distorted and blurry. This may signify the development of a macular hole.

The macula is a tiny spot in the retina of the back part of the eye. The macula contains light-sensitive cells called cones and rods which are responsible for day and night vision.

Macular holes are often related to aging processes affecting people over the age of 60. When there is a development of a macular hole, a sudden decrease in the vision of one eye may be noticed. Macular holes are different from macular degeneration and they may occur due to:

  • A detached retina
  • Diabetic eye disease
  • High degree of nearsightedness (myopia)
  • Vitreous shrinkage and/or separation
  • Macular pucker
  • Best’s disease
  • Eye injury

The vitreous body or the clear gel-like fluid that fills the eye and keeps its shape becomes more liquid with aging. This causes it to shrink and pull the retina making tears and holes. If these holes and tears in the retina happen to be in the area of the macula, it is called macular hole.

Macular Holes

Macular Hole Progression

Macular holes occur in three stages:

Foveal detachments — nearly 50% worsen with no treatment.
Partial-thickness holes — around 70% get worse without treatment.
Full-thickness holes — most worsen with no treatment.

Some cases of macular holes are resolved without treatment, but most require medical intervention to prevent blindness.

Macular Holes

Macular Hole Treatment and Surgery

The most common treatment to repair macular holes is a vitrectomy. This surgery involves the removal of the vitreous gel to hinder it from pulling on the retina. Then, a mixture of air and gas is inserted into the space previously occupied by the vitreous body which will then put pressure on the edges of the macular hole and heal it.

While the bubble does its job, you need to lie face down so that the bubble will remain in place which can take 2-3 weeks! It may be obnoxious to stay still for a long period of time, this is the best option to achieve the best vision after developing a macular hole.

The gas and air bubble will slowly go away over time and are replaced with natural eye fluids while the hole heals. Infection, cataract, and retinal detachment are some of the risks you should watch out for in vitreous surgery. Fortunately, these are all treatable.

Keep in mind that traveling is prohibited for several months for a person who has undergone macular hole surgery. This is because the gas bubble may expand with changes in pressure and cause eye damage.

People who had a macular hole on one eye have a 10% chance of developing another macular hole on the other eye. Therefore, it is highly recommended to undergo regular eye exams as prescribed by your eye doctor to catch complications as early as possible.

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