What are macular holes?

As we age, our vison may deteriorate due to several conditions that may affect our eyes. One potential cause could be the development of a macular hole, but what are these holes exactly? Highly esteemed consultant ophthalmologist Mr Abdallah Ellabban, who practices in East Riding of Yorkshire and Hull, explains in detail what causes macular holes, what the associated symptoms are, and whether they are the same as age-related macular degeneration. In his following article, he outlines how macular holes can be treated. 

What is a macular hole?

The retina is the thin layer of sensitive tissue lining the back of the eye. The retina functions much like the film in a camera and transmits light signals to the brain. The central and most sensitive part of the retina is called the macula. 

A macular hole is a small gap or defect in the macula. Macular holes occur in about 3 in a thousand people over the age of 55 years. Women are three times as likely to develop a macular hole as men are.

Macular holes can be diagnosed by clinical examination or with the aid of a retinal scan called optical coherence tomography (OCT). The scan captures cross-section images of the retina and will demonstrate the hole in the central part of the macula. This test is also important to differentiate macular holes from other conditions that may affect the central part of the vision.

What causes a macular hole? 

A healthy eye is filled with vitreous, a gel-like substance. The gel is usually in contact with the retina. As we age, the vitreous shrinks and separates from the surface of the retina. This process is called posterior vitreous detachment (PVD) or separation.

In most people, the vitreous separation does not cause any problems. However, in some people, the vitreous is abnormally adherent to the macula. So, when the vitreous starts to separate from the retina, it may pull away from the central part of the macula, causing the hole to form.

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

Macular holes and macular degeneration are two different conditions. However, both conditions can affect the central part of the vision and may cause similar symptoms like blurred central vision. The diagnosis can be easily made by clinical examination and with the aid of retinal scan called OCT scan.  

What are the symptoms of macular hole? 

Patients who develop a macular hole may experience different symptoms, like:

• blurring of the central vision 
• straight lines appear distorted or wavy
• patch of missing vision at the centre
• dark spot or a gap in the centre of your vision.
• decrease in the ability to see fine details, especially for reading.

What is Amsler grid?

Amsler grid is a simple square that contains a grid pattern and a dot in the very centre. This grid can help to show if you have any problems with the central vision. It is recommended that all patients over 55 years regularly check their vision with the Amsler grid. This may help for early detection of any problem in the central vision. If areas of the grid are dark, wavy, or blurry, book a consultation with an ophthalmologist to get the back of the eyes examined.

Can I develop a macular hole in my other eye?

If you develop a macular hole in one eye, there is about a ten percent chance of developing another in the other eye. Therefore, it is important to monitor for any changes in the vision. You can use the Amsler grid for regular self-monitoring and report any changes to your eye specialist.  

Mr Abdallah Ellabban is an experienced dual-qualified consultant ophthalmologist, practising in East Riding of Yorkshire and Hull. If you would like to book a consultation with him, you can do so via his Top Doctors profile.