The macula is the part of your eye located in the middle of your retina. It gives each eye the clear, central vision you need for reading, driving, and distinguishing details. A small tear or break in your macula is called a macular hole. It is usually caused by the separation or shrinkage of the vitreous (a gel-like substance in your eye) from your retina.
UPMC experts provide advanced surgical treatment for people experiencing a macular hole, reducing the risk of vision-threatening complications.
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What Is a Macular Hole?
The macula is a part of your eye located in the middle of your retina. It gives your eyes the clear, central vision you need for reading, driving, and distinguishing details. A small tear or break in your macula is called a macular hole. It is usually caused by the separation or shrinkage of the vitreous (a gel-like substance in your eye) from your retina.
How serious is a macular hole?
If left untreated, macular holes can cause vision-threatening complications. Getting fast treatment can reduce your risk of permanent central vision loss.
What are the types of macular holes?
There are two types of macular holes:
- Primary macular hole — Occurs without an eye injury and is not associated with any other medical condition.
- Secondary macular hole — Caused by another condition, such as an eye injury or inflammation due to uveitis.
What are the stages of macular holes?
There are three stages of macular holes, including:
- Foveal detachment (stage 1) — Affects the central part of your retina called the foveal depression, which controls sharpness and detail in your central vision.
- Partial-thickness hole (stage 2) — A hole that does not extend through all the layers of your macula.
- Full-thickness hole (stage 3) — A complete hole that extends through all layers of your macula.
How common are macular holes?
Macular holes are uncommon, affecting about 8 of 100,000 people per year. They are more common in older people and women.
What causes macular holes?
Age-related eye changes are the most common cause of a macular hole. It is usually caused by the separation or shrinkage of the vitreous (a gel-like substance in the eye) from the retina. Macular holes can also be caused by eye injury or other eye-related medical conditions.
Macular hole risk factors
Risk factors for macular holes include:
- Being over age 60.
- High degree of nearsightedness (myopia).
- History of diabetic eye disease.
- Macular hole in your opposite eye.
- Previous eye injury.
Complications of macular hole
If left untreated, a macular hole can cause vision-threatening complications, including:
- An increase in the size of the macular hole.
- Retinal detachment.
- Central vision loss.
How can I prevent a macular hole?
There is nothing you can do to prevent a macular hole. However, managing chronic conditions that may affect your eyes, such as diabetes and high blood pressure, and having regular eye exams can help identify early signs of a macular hole.
What Are the Signs and Symptoms of a Macular Hole?
Symptoms of macular holes often begin gradually. In the early stages, you may notice a slight distortion or blurriness when you look straight ahead, and objects may appear twisted or wavy.
As the condition worsens, symptoms may include:
- A blurred or blind spot in your central vision.
- Difficulty reading, writing, or driving.
- Objects look like they are missing pieces in the center, such as the difficulty of seeing someone’s nose on their face or the words in the center of a line of text.
When should I see a doctor about my macular hole symptoms?
If left untreated, a macular hole can lead to permanent vision loss. If you have macular hole symptoms, it’s important to see your ophthalmologist or retinal specialist right away. Receiving an early diagnosis and treatment improves your chances of successful treatment, which can restore your vision.
How Do You Diagnose a Macular Hole?
Your ophthalmologist will perform an eye exam and look at your retina when your pupils are dilated.
What to expect during your visit
If your doctor suspects a macular hole, they will:
- Ask about your symptoms.
- Perform an eye exam by dilating your pupils.
- Review your health history and medications.
Tests to diagnose a macular hole
Your ophthalmologist will perform several tests to diagnose a macular hole, including:
- Eye exam with dilation.
- Optical coherence tomography (OCT), which uses light to take detailed images of your retina.
- Retinal exam.
Macular hole prognosis
Early surgical treatment for a macular hole improves your chances of a complete recovery, especially if the macular hole is small. However, if left untreated, a macular hole may cause you to lose most of your central vision.
How Do You Treat Macular Hole?
The goals of macular hole treatment are to restore your central vision and prevent vision-threatening complications.
Can a macular hole be treated without surgery?
Although a small percentage of macular holes may heal on their own, treatment typically involves a surgical procedure called a vitrectomy.
Vitrectomy surgery to treat macular holes
Macular holes typically are treated with a surgical procedure called a vitrectomy.
During this surgery, your retina specialist will:
- Remove your eye’s vitreous gel to prevent it from separating from your retina. This will also prevent other eye fluids from leaking behind your retina, which can worsen your condition.
- Replace the vitreous with a bubble mixture of gas and air that puts pressure on the edges of the macular hole, allowing it to heal.
For the bubble to press against your macula and seal the hole, you must remain in a face-down position for several days. Over time, the air and gas bubble will be reabsorbed by your eye, and your vitreous cavity will refill with natural eye fluid.
How long do you have to be face down after macular hole surgery?
You will have to remain in a face-down position for three to seven days after your macular hole surgery, depending on your surgeon’s recommendation.
Why Choose UPMC for Macular Hole Care?
When you choose UPMC for macular hole care, you will receive:
- Access to ophthalmology expertise — Our ophthalmology experts treat the full spectrum of conditions using the latest, evidence-based treatment guidelines and strategies.
- A full range of treatment options — We offer general ophthalmology and retinal care that allows us to effectively treat all types of eye disorders while reducing your risk of complications.
- Multidisciplinary care — We partner with retinal specialists, primary care providers, and other medical experts to provide complete care that optimizes your recovery and quality of life.
