What Causes a Macular Hole?

A macular hole forms when the vitreous gel inside the eye pulls hard enough on the center of the retina to tear an opening in it. Increasing age is by far the most common reason this happens.

As we get older, the vitreous gel that fills the eye shrinks and condenses, gradually separating from its firm attachment at the center of the retina. This separation is a natural part of aging and usually causes no trouble. Occasionally, though, the vitreous stays stuck to the macula as it pulls away, and the traction opens a hole.

Beyond age, other retinal diseases and eye trauma can also lead to a macular hole.

How is a Macular Hole Diagnosed?

A macular hole is diagnosed with a dilated eye exam, during which your ophthalmologist uses special lenses to examine the retina.

Optical coherence tomography (OCT) imaging is essential to the diagnosis. The OCT machine noninvasively scans the back of your eye and produces microscopic cross sections of the retina and macula, showing the hole clearly, along with its size and stage. Those same scans also detect a range of other retinal diseases and allow your surgeon to plan treatment precisely.

How is a Macular Hole Treated?

Most macular holes require surgery, though a small hole occasionally closes on its own. The procedure is called vitrectomy with membrane peel, and it is the most effective treatment available.

During the operation, your retina surgeon removes the vitreous that is pulling on your macula, then peels away a fine layer of tissue from the retinal surface to help the hole close. A gas bubble is left inside the eye, where it flattens the macular hole and supports the retina while it heals. The bubble dissolves on its own over several weeks.

What Should I Expect After Macular Hole Surgery?

Recovery from macular hole surgery asks more of patients than most eye procedures, largely because of the positioning required. Here is what to expect:

• Mild pain or discomfort after surgery.

• An eye patch worn at night to protect the eye, along with eye drops for several weeks.

• Face down or reading positioning at all times for up to a week after surgery. This keeps the gas bubble pressed against the macula so the hole can heal properly, and following the instructions closely makes a real difference in the outcome.

• No flying in an airplane until the gas bubble has completely dissolved. Flying while the bubble remains can cause a rapid rise in eye pressure and permanent vision loss.

• Tell any doctor treating you that you have a gas bubble in your eye, because the bubble can react with certain types of anesthesia if you need another surgery.

• Vision usually improves once the macular hole closes, though maximal improvement can take several months. Your final vision depends on how large the hole was before surgery and how long it was present before it was repaired.

What Are the Risks of Vitrectomy Surgery?

Like any surgery, vitrectomy carries risks. These include:

• Infection.

• Bleeding.

• A retinal detachment.

• Glaucoma, or increased eye pressure.

• Cataract, a clouding of the lens.

Your retina specialist will discuss these risks with you, along with how vitrectomy surgery may help in your particular case.

Frequently Asked Questions About Macular Hole

Is a Macular Hole an Emergency?

A macular hole is not an emergency in the way a retinal detachment is, but it should not be put off either. Time matters: holes that are repaired sooner, while they are still small, tend to close more reliably and yield better final vision than those left for months. If you notice new distortion, waviness, or a dark spot in your central vision, schedule an evaluation with a retina specialist promptly.

Does a Macular Hole Cause Blindness?

No. A macular hole affects only your central vision and leaves your peripheral vision fully intact, so it does not cause total blindness. It can, however, take away the sharp detail vision you need for reading, driving, and recognizing faces, which is why treatment is worth pursuing.

Will a Macular Hole Get Worse?

Often, yes. Untreated macular holes tend to enlarge over time, and as they grow, the dark spot in the center of your vision becomes more noticeable and surgical results become less predictable. Occasionally a small, early hole closes spontaneously, but waiting for that is not a strategy your retina specialist will usually recommend.

Can a Macular Hole Come Back After Surgery?

Reopening is uncommon. Most macular holes stay closed permanently after successful surgery, though a hole occasionally reopens, and additional surgery may then be considered. Your retina specialist monitors the macula with OCT imaging afterward to confirm the hole remains closed.

Is a Macular Hole the Same as a Macular Pucker?

No, though the two are closely related and often confused. A macular pucker is scar tissue that wrinkles the surface of the macula, while a macular hole is an actual opening in the macular tissue. Both arise from the vitreous pulling on the retina with age, both distort central vision, and both are repaired with vitrectomy and membrane peel. The key difference is that macular hole surgery adds a gas bubble and face down positioning, since the hole must be held closed while it heals.

Can a Macular Hole Be Prevented?

Not realistically. A macular hole results from the natural, age related separation of the vitreous from the retina, and no diet, supplement, or eye exercise has been shown to prevent it. What you can do is protect your eyes from injury, keep other retinal conditions under treatment, and have regular dilated eye exams after age 60, so that if a hole does form it is found while it is small and most treatable. Monitoring your central vision at home, one eye at a time, is one of the simplest ways to catch a change early.

If your central vision has become wavy or distorted, or a dark spot has appeared in the center of your sight, please contact Florida Retina Institute or call our office to speak with a member of our team. With 21 locations throughout Florida and Georgia, expert vitreoretinal care is always close to home.