Macular hole – symptoms, causes & treatments
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Macular Hole

A break or hole in the macula usually affects those aged 60 and over, and can cause blurred and distorted central vision.

The macula is the tiny, central area of your retina (the focusing surface at the back of your eye). It allows you to see things directly in front of you, and also lets you see colour and detail. A hole in the macula can cause blurring, blank spots and distortion of your central vision.

Eye Diagram showing macular    Eye Diagram showing macular
Left: Macular hole in a black and white photograph
Macular hole in a colour fundus photograph

Macular hole symptoms

The symptoms of a macular hole are quite similar to those of macular degeneration. Like macular degeneration, it is also most common in people aged 60 and over. However, the conditions are quite different, and you should see an eye specialist if you suspect either.

A macular hole generally only affects your central vision, so your peripheral or ‘side’ vision will remain unaffected. You may have difficulty with reading and close work, and you may notice grey or black spots, or blank areas, in your vision. Macular holes usually affect one eye, rather than both, although it is possible for both eyes to be affected by macular holes.

Macular holes usually develop over time, so you may not notice any symptoms until your vision is affected. Early signs include blurring and distortion of your vision, and you may notice straight lines (such as window frames, telegraph poles or lines of text) appearing bent or wavy. The Amsler Grid is a simple test that will help you determine if your vision is distorted in this way.

Eye Diagram showing macular    Eye Diagram showing macular
Left: An Amsler Grid with straight lines as seen by a normal-sighted person. Right: A person with macular degeneration may notice distortion of the grid pattern such as bent lines and irregular box shapes or a grey shaded area

The size and location of the macular hole will determine how much it affects your vision. There are also three stages of macular hole, and vision will generally deteriorate as the condition worsens.

Causes of macular holes

As we age, the vitreous ‘gel’ inside the eye naturally shrinks and pulls away from the retina. Occasionally, the vitreous gel can pull on the retina and create a macular hole. In some cases, the fluid that fills the gap left by the vitreous gel may seep through the hole onto the macula, causing blurring and distortion.

Other conditions that increase the risk of a macular hole

The presence of another eye condition may increase your chances of developing a macular hole. These include:

Treatment for a macular hole

Macular hole treatment is generally most effective when carried out early in the development of the condition. An operation called a vitrectomy is used to carefully remove the vitreous ‘gel’ from the affected eye, and replace it with a gas that helps the macula heal.

Eye Diagram showing macular    Eye Diagram showing macular
Left: Macular hole before surgery
Macular hole after surgery

Eye Institute surgeons are renowned experts in vitreoretinal surgery, so if you suffer form a macular hole, make an appointment to discuss your treatment options today.

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