Macular Hole

Eyesight depends on a complex series of interactions between the different parts of the eye. (Read about "The Eye") The macula is a tiny oval area made up of millions of nerve cells located at the center of the retina. The retina is the light-sensitive tissue at the back of the eye. The macula is responsible for sharp, central vision. A macular hole is just that: a hole in the macula.

Causes and symptoms

The eye contains a jelly-like substance called the vitreous. Shrinking of the vitreous usually causes the hole. As a person ages, the vitreous becomes thicker and stringier and begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result.

The size of the hole and its location on the retina determine how much it will affect vision. Generally, people notice a slight distortion or reduction in their eyesight. However, if the hole goes all the way through the macula, you can lose a lot of your central and detailed vision.

A macular hole is not the same as macular degeneration. (Read about "Macular Degeneration") They are two different diseases even though they have similar symptoms. An eye care professional will know the difference.

Treatments

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids. Following surgery, patients must usually keep their faces tilted down for two or three weeks, according to American Academy of Ophthalmology (AAO). This position allows the bubble to press against the macula and seal the hole. Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. (Read about "Cataracts") Other less common complications include infection and retinal detachment either during surgery or afterward. (Read about " Retinal Detachment")

NEI says the surgery is about 90 percent effective in closing the hole. However, improvement in people's vision is more variable. More than half of those who have the surgery can expect an improvement of two lines or more on the vision chart.