A macular hole is a hole in the macula, the sensitive part of the retina that is located at the back of the eye. The macula contains light-sensitive cells which provide clear, sharp central vision. Specifically, the hole or defect occurs in the fovea, the center of the macula and the most delicate part of the entire retina.
Causes of a Macular Hole
Macular holes almost always develop as a result of the natural aging process, when the vitreous, the gel that fills most of the eye, thins and separates from the macula. This can produce a pull on the macula causing a hole to develop. Less commonly, macular holes can be caused by:
- Eye injury
- Intraocular inflammation
- Retinal detachment
- Macular pucker
Most cases of a macular hole occur in people over the age of 60.
Stages of a Macular Hole
There are three stages of a macular hole, they are:
- Stage 1 - foveal detachments
- Stage 2 - partial thickness macular holes
- Stage 3 - full thickness macular holes
Each stage can progress to the next if not treated. When a stage 3 macular hole develops, most of the central and detailed vision is affected.
Symptoms of a Macular Hole
At first a macular hole may only cause a small blurry or distorted area in the center of vision. As the hole grows over several weeks or months, central vision progressively worsens. Peripheral vision is not affected, and there is low risk of complete blindness.
Treatment of a Macular Hole
While some macular holes resolve on their own, in most cases surgery is required to effectively restore vision. The success rate of the surgery varies based on the severity of the condition. An outpatient procedure, known as a vitrectomy, is performed to replace the vitreous gel, and a gas bubble is injected into the eye to help close the hole. As the eye heals, the fluid is naturally replaced. There is a new recently FDA approved alternative to treat macular holes that is called Jetrea. The medicine is injected directly into the eye under topical anesthesia in the office setting. The doctor will inform you if you are a good candidate for this new treatment.