What Causes a Macular Hole? 

The most common cause is aging. As the gel-like substance in your eye (called the vitreous) changes, it can pull away from your retina. Sometimes, it tugs too hard on the macula, causing a hole to form.

 

What are the Symptoms of a Macular Hole? 

• Blurred central vision: Objects in the center of your vision may look blurry or out of focus.

• Distorted vision: Straight lines may appear wavy or bent.

• Blind spot: A dark or missing spot may appear in the center of your vision.

 

How is a Macular Hole Diagnosed? 

• A macular hole is usually diagnosed initially by an optometrist or ophthalmologist using a special imaging tool called optical coherence tomography (OCT), which takes detailed scans of the eye. 

• Once they suspect or diagnose a macula hole, the patient is then referred to me for further care. 

 

How is a Macular Hole Treated? 

The only way to treat a macular hole is with eye surgery, called a vitrectomy. During a vitrectomy, the vitreous (sticky gel within the eyeball) is removed and replaced with a gas bubble, which pushes the retina to close the hole and heal. You will need to keep your head in a “face-down position” for a period of time to help the gas bubble keep the hole closed.

 

How successful is surgery for a macular hole?  

Macular holes that are detected and operated on early typically do well, with the chance of success from one operation being over 95%.  

Macular holes that have been there for months and/or are large in size are a little more “stubborn” and will at times require a second operation.

 

What can I expect if I have surgery? 

Surgery is usually done under local anaesthetic with some mild sedation i.e. anaesthesia is used to numb the eye whilst some relaxing medication is given via a drip. 

All you have to do is lie still on your back, listen to the relaxing music being played whilst the surgery is performed. This takes approximately 45 minutes. 

After surgery, a pad is used to cover your eye, and you are then discharged home. You will need to position your head in a face-down position (chin-to-chest when sitting up/lying on tummy with face down as much possible) for 3 days after surgery to maximise the chance of successful hole closure. 

 

How long does recovery take? 

I usually advise patients to take at least 1-2 weeks off work and will provide a medical certificate for this. The gas bubble in your eye typically disappears in about 2-3 weeks, during which you cannot fly or travel to places with a significant change in atmospheric pressure (mountains or diving).  

 

During these 2 weeks, take it easy, avoid any straining or heavy lifting, keep the eye clean, read a book, spend time with the family, watch some Netflix and go out for nice leisurely walks! 

Visual recovery will be gradual and will take weeks to months - the retina, which is a very delicate and intricate structure needs time to recover even though the hole usually closes within the first 3 days. 

 

Are there any risks of surgery? 

Yes, as with any surgical procedure (or even daily activities such as driving), there is always a chance that complications can happen. Fortunately however, the risks of serious complications such as an infection inside the eyeball (endophthalmitis) are very low - the risk of this is approximately 1 in 3000 (0.03%). The other way of viewing it is that if surgery is not performed, there is a 100% chance of no improvement and very likely worsening of vision. 

Click here for a more detailed explanation of the risks of surgery.