An introduction to macular holes

In his latest online article Mr Bhaskar Gupta gives us his insights into the macular hole. He explains what it is, why it happens and the treatment.

What is the macula?

Our eyes have a layer at the back that reacts to light, like the film in a camera. This layer is the retina, and it helps us see by capturing the light that comes through the eye. The middle part of the retina is the macula, which is very important for seeing clearly. We need the light to hit the macula if we want to see small details, read words, or see different colours.

What is a macular hole?

The retina has a hole in the middle that looks like a circle. This makes the vision blurry or twisted, so that things that are straight, like lines or words, seem to bend or curve. There might also be a spot in the middle where nothing can be seen.

Is a macular hole the same as age-related macular degeneration?

They are different problems, macular holes and macular degeneration, but they affect the same area in the eye. It is possible for both of them to occur in the same eye at the same time.

Why does it happen?

We do not know why macular holes form. They are more common in people between 60 and 80 years of age, and women have them twice as much as men. We think that people who have a little trouble seeing far away are more likely to get them. Some other things that can cause macular holes are a bad injury to the eye, being very near sighted, having the retina come off the back of the eye, or having fluid build-up in the middle of the retina for a long time.

Can I develop a macular hole in my other eye?

A close look can tell how likely it is that you will get a macular hole in your other eye. Your surgeon will let you know your chances, but they could be anything from very low to 10%. You should watch out for any changes in how well you can see with your other eye, and tell your eye doctor/family doctor/eye glasses maker right away.

What would happen if I did not have my macular hole treated?

Some macular holes can close on their own without treatment, and the vision can improve. But for most people, the vision in the centre will gradually get worse and they might not be able to read the largest print on an eye test chart. The condition does not affect the vision around the edges, so people cannot go totally blind from this condition.

What is the treatment and how successful is it?

A macular hole can be closed with surgery and if the hole has been there for less than a year, the operation will succeed in 90% of cases. Of these, more than 70% will be able to see 2-3 lines more clearly on the vision chart, compared to before the surgery. Even if the vision does not get that much better, it will not get worse and many patients find that things look less twisted. In a few cases, the hole does not go away after surgery; a second surgery can still close the hole.

You should know that your vision will not be perfect again and that how much your vision gets better depends on things other than just making the hole go away, especially how well the cells in the retina that sense light (photoreceptors) is working. Big macular holes and Macular holes that have been there for a long time usually do not get better as much.

Mr Bhaskar Gupta is a highly experienced Ophthalmologist with over 15 years of experience in his field. To schedule an appointment with Mr Gupta, visit his Top Doctor’s profile today.