The macula is part of the back of the eye (retina) responsible for central vision. A macular hole simply refers to a tear or opening in the macula. A hole in the macula can cause vision to be distorted, wavy or out of focus. As the hole grows bigger, the patient will see a dark or blind spot in the centre of their vision.
As the macula is responsible for central vision, during a macular hole peripheral vision is not affected.
The most common cause of a macular hole is age. As we grow, naturally the jelly like fluid (vitreous) inside the eye shrinks and pulls away from the retina. Usually this pulls away without any problems however sometimes it may stick to the retina, this can cause the macula to stretch and form a hole. Macular holes can also form as a result of macular swelling (edema) or traumatically.
If you feel like you may be experiencing any symptoms of a macular hole it is very important to have an ophthalmologist examine the fundus (back of the eye) urgently. This is performed by dilating the pupil to have a clear view of the interior part of the eye through a special high magnification lens. Your ophthalmologist may also take detailed pictures of the inside of your eye using an OCT (Optical Coherence Tomography) machine which scans the back of the eye providing detailed pictures of the retina and macula. These pictures help confirm the findings.
The best treatment for a macular hole is undergoing a surgery known as a vitrectomy. During a vitrectomy an ophthalmic surgeon removes the vitreous that is pulling on the macula and inserts a gas bubble into the eye. The purpose of the gas bubble is to flatten the macular hole and hold it in place as the eye heals. The bubble eventually dissolves away on its own. A vitrectomy is a major procedure and requires strict post-operative care such as making sure to keep your face in a certain position. No flying, mountain climbing, scuba diving or any activities where sudden change in altitude is involved to prevent any pressure build up in the eye. Vision will improve as the hole closes. Recovery can take several months depending on the size of the macular hole and how long it had been there prior to the vitrectomy. A vitrectomy just like any other surgery carries its own risks, which your ophthalmologist will inform you of prior to surgery.