Macular Hole

Macular Hole

Posted under Eye Conditions, Living With Low Vision, Low Vision Info

Leslie, I have a macular hole, my friend Laura tells me over the phone after being seen at an urgent appointment with a retina specialist. Laura could usually see and read without the need for her reading glasses, but when her vision started becoming blurrier, she noticed that her glasses didn’t seem that helpful despite continually cleaning the lenses. The small blur was straight ahead in her central vision. She could see clearly and had sharp vision if she directed her vision to the right or to the left – but blurriness when she looked straight ahead. She thought she may need a new eyeglass prescription and made an eye appointment. After a retina exam by her eye doctor, he referred her to a retina specialist that same day who diagnosed my friend with a macular hole.

What is a Macular Hole and What Causes It?

“Macular holes are related to aging and usually occur in people over age 60,” according to the National Eye Institute. My friend will concur as she just turned 60. The cause of a macular hole is when the vitreous, gel-like substance that fills most of the eye’s interior chamber begins to shrink and pull away from the retinal surface. Millions of fine fibers are attached to the surface of the retina and as we age, the vitreous slowly pulls away from the retinal surface. This “tugging” can tear the retina and cause a hole. “The size of the hole and its location on the retina determine how much it will affect a person’s vision. When a Stage III macular hole develops, most central and detailed vision can be lost. If left untreated, a macular hole can lead to a detached retina, a sight-threatening condition that should receive immediate medical attention.” explains the National Eye Institute article Macular Hole.

What are the symptoms of a macular hole?

Many symptoms of a macular hole are similar to those of macular degeneration, but they are two different retinal conditions. The most common symptoms are blurred central vision, distortion such as straight lines looking wavy, and when reading print becomes more of a strain and struggle.

How is a macular hole treated?

Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision and to prevent a retinal detachment. In my friend’s case, surgery is required along with 3-4 days of maintaining a face-down position. The surgical procedure is called a vitrectomy. A vitrectomy is when the vitreous gel is removed to prevent it from pulling on the retina and replaced with a bubble containing a mixture of air and gas. The bubble acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals. Surgery is performed under local anesthesia and often on an out-patient basis.

Following surgery, patients must remain in a face-down position, normally for a day or two but sometimes for as long as two weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the bubble dissolves, the vitreous cavity refills with natural eye fluids. At a Glance: Macular Hole by the National Eye Institute

Leslie Degner, RN, BSN