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 in the development of a macular hole, they are as follows:
- Stage 1 - foveal detachment
- Stage 2 - partial thickness macular hole
- Stage 3 - full thickness macular hole
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 lost.
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 no risk of 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 no other non-surgical alternative to treat macular holes.
Left untreated, a macular hole can develop into a detached retina.
A macular pucker, also known as an epiretinal membrane, is a thin layer of scar tissue that forms over the macula, the sensitive part of the retina that is located at the back of the eye. The macula is the area of the retina that provides clear, sharp central vision.
Causes of a Macular Pucker
Macular puckers often develop on their own as a part of the natural aging process. Particles that have drifted into the vitreous (the gel that fills the eye) settle onto the macula and begin to obscure vision. Membranes may also result from eye conditions or diseases such as diabetic retinopathy, retinal detachment, inflammation, injury or vascular conditions. These are called secondary epiretinal membranes, whereas spontaneously formed membranes are called idiopathic.
Symptoms of a Macular Pucker
Many macular puckers do not disrupt vision. Thicker puckers can create wrinkles or puckers in the macula resulting in some of the following symptoms:
- Blurry or distorted vision
- Straight lines appear as wavy lines
- Difficulty with fine detail or print
A macular pucker typically affects one eye. Vision loss varies based on the thickness of the pucker. Peripheral vision is not affected and there is no risk of blindness.
Diagnosis of a Macular Pucker
After a thorough examination of the eye, the physician will perform a series of diagnostic tests. These tests may include:
- Dilated eye examination
- Fluorescein angiography
- Optical coherence tomography (OCT)
Treatment of a Macular Pucker
While some macular puckers heal on their own, surgery is recommended for those that do not. Vitrectomy is performed as an outpatient procedure with local anesthesia. During the procedure, the vitreous gel is removed and replaced with a saline solution that will fill the eye and lift the pucker away from the macula. There is no non-surgical alternative to treat a macular pucker.