The retina is the layer of light-sensitive tissue that lines the back of the eye, and the macula is the center portion of the retina. If the macula develops a problem, it can affect central vision while leaving peripheral vision intact. As a result, objects in the center of the visual field can appear blurry or distorted (i.e., straight lines look wavy); there may be blind spots in a portion of the central vision as well.

A macular hole is a tear in the macula. The visual effects of a macular hole are similar to macular degeneration; but unlike macular degeneration, which cannot be cured, macular holes can be treated, especially when caught early on.

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Understanding Macular Holes

The eye is filled with a clear vitreous gel that gives the eye its shape. Over time, the vitreous liquefies and separates from the retina at the back of the eye. As it separates, it can tug on the macula; occasionally, a membrane can form on the retina that tugs on the macula, too. This tugging can lead to a hole in the macula.

Symptoms of Macular Holes

Symptoms of a macular hole may include the following:

  • Grey, black, or blank areas in central vision
  • Blurred or distorted images
  • Increased difficulties with close-up work such as reading or focusing on a face

If you have developed a macular hole in one eye there is a 10 to 15 percent chance you will develop one in the other as well. Your risks for this will be discussed in greater detail during your treatment consultation at our San Diego offices.

If you are experiencing any of the symptoms of a macular hole, please contact California Retina Associates to schedule an examination today. Early diagnosis leads to the best chances of treating the condition and preserving clear vision.

What causes macular holes? Can they be prevented?

Macular holes are more likely to develop if a person is over age 60. That’s because the vitreous gel that fills the eye becomes more liquid over time. This allows it to move around inside the eye more. Since the vitreous is attached to the retina with tiny strands of cells, it can pull on the retina as it shrinks and moves. This can tear off a small piece of the retina, causing a hole. If this piece happens to be in the macula, this is a macular hole.

Another direct cause of macular holes due to vitreous shrinkage is when the strands of cells stay attached to the retina and break away from the vitreous. These strands can contract around the macula, causing the macula to develop a hole from the traction.

An image of someones retina that has Macular degeneration. These are all the possible causes of macular holes:

  • Vitreous shrinkage and/or separation
  • Diabetic eye disease
  • High amounts of nearsightedness
  • Macular pucker
  • A detached retina
  • Eye injury
  • Best’s disease

Because almost all macular holes develop spontaneously without an obvious cause that could be foreseen, there isn’t any effective way to prevent their formation. Usually a macular hole will develop in just one eye.

Macular Hole Treatment

Around 50 percent of macular holes will progress to the point where treatment is necessary. The best way to determine if treatment is important to preserve your vision is through an examination with one of our experienced eye surgeons.

Macular holes are usually treated with vitrectomy, the same surgical procedure used to treat retinal detachment. This procedure will not require an overnight stay in the hospital but will necessitate some physical limitations for a short time during recovery.

The vitrectomy procedure entails removing vitreous gel and replacing it with a saline solution, gas, or silicone oil. If there is a membrane tugging on the macula, that can be removed too. This approach closes the macular hole. Following your procedure, you will be provided with an eye patch and special instructions to help reduce complications. These will include some physical limitations, though most people are able to resume working and similar activities within 24 to 48 hours of their vitrectomy.

Are macular holes serious? What happens if you don’t treat a macular hole?

If you develop a macular hole, these are ways it may impact your vision in that eye:

  • There will be a decrease in the ability to see fine details when you’re looking directly at an object, no matter how close or far away it is.
  • You will have a change in vision, so you feel as if you’re looking through a dense fog or thick, wavy glass.
  • You will have a dark spot across the middle of the field of view.

If you have these symptoms, it’s important to come see the experts at California Retina Associates. Left untreated, most macular holes will worsen with time. Because the macula is the area of the eye that is responsible for seeing crystal clear, color vision, this isn’t something to trifle with.

Can a macular hole heal without treatment?

It is possible in some instances for a macular hole to heal without treatment, but are you going to count on that possibility at the risk of permanent vision damage? About 50 percent of macular holes will progress to the point where surgery is required to preserve the patient’s vision. Once we check your eye with a test called optical coherence tomography, we can tell if your macular hole needs treatment or if we should wait and see if it heals. This can only happen with partial tears. And it can only happen if we see you in our offices.

How are macular holes different from macular degeneration?

Macular holes occur when some or all of the neurons in the center of your macula are pulled out of position, in most cases due to traction from the vitreous.

Age-related macular degeneration is completely different. It is a disease where deposits called drusen form under the retina and the light-sensitive cells (photoreceptors) of the macula slowly break down. This is dry age-related macular degeneration. When abnormal, leaky blood vessels grow behind the macula, vision loss occurs from the death of the photoreceptors. This is wet age-related macular degeneration.

The symptoms of both conditions, blurred vision in the central visual field that can progress to central blind spots with time, are similar.

Who is a good candidate for macular hole treatment?

Regardless of whether or not a macular hole will need surgical treatment, if you have any of the symptoms above, you need to see an eye professional. About half of the people with macular holes will need treatment, usually, a surgery called a vitrectomy.

In a vitrectomy, our California Retina Associates ophthalmologists remove the vitreous gel inside the eye and it is replaced with saline solution, gas, or silicone oil.

If you’re over 60, it’s likely traction from your vitreous is pulling on the retina and has caused your macular hole. If the area torn away is only a partial thickness tear, we may opt to see if it will heal on its own. But tears of over half the thickness will usually require a vitrectomy.

If you have any further questions that you would like answered, please feel free to visit our macular degeneration frequently asked questions page.

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More Information on Macular Degeneration:

Contact California Retina Associates

The treatment option or combination is best for you will be determined by a member of our San Diego macular hole treatment team. To schedule, a consultation with one of our California retina specialists at our Chula Vista location call 619.425.7755, for La Mesa call 619.425.7755, and if your located in El Centro call 760.352.7755. You can also fill out our contact us form and we’ll reach out to you at our earliest convenience. We will discuss your needs and concerns, and determine your best course of action.