Macular Hole

Description

The macula, is a very small spot in the back of the eye (retina). Light focuses sharply at the macula which allows for visual acuity and colour vision. Macular hole is a problem that affects the macula, and people will notice a sudden decrease in vision in the eye where the hole has occurred. It happens for a variety of reasons such as eye injuries, certain diseases, and inflammation inside the eye. However, the most common cause is related to the normal aging process. Women have a slightly higher risk for macular holes than men. The vitreous gel inside the eye is firmly attached to the macula. With age, the vitreous becomes thinner and separates from the retina. Sometimes this creates traction on the macula, causing a hole to form. Macular holes often begin gradually and affect central vision depending on the severity and extent of the problem. Partial holes only affect part of the macular layers, causing wavy, distorted, blurred vision. Patients with full-thickness macular holes experience a complete loss of central vision.

Symptoms

Macular holes usually develop over time, so you may not notice symptoms straight away. The severity of the symptoms is dependent on whether the hole is partial or full-thickness. A macular hole only affects your central vision so your peripheral (side) vision should remain unaffected. Symptoms such as difficulty with reading and close-up work, as well as noticeable grey, black, or blank spots in your vision can occur with a macular hole. People with a macular hole also notice their vision blurring or distorting as well as noticing straight lines such as window frames and lampposts appearing as bent or wavy.

Causes

The vitreous inside the eye, a gel like substance, is permanently attached to the retina. As we age, the vitreous begins to naturally shrink and pulls away from the retina. Occasionally, the vitreous pulls on the retina and this traction causes a macular hole. In some instances, the fluid that fills the eye can enter the hole in the retina and cause blurred, distorted vision. Other conditions have also been linked to the development of a macular hole including;
  • Severe short-sightedness
  • Retinal detachment
  • Diabetic retinopathy
  • Eye injury or trauma
  • Epiretinal membrane progression

Diagnosis

Macular holes are diagnosed through a number of tests which are important for providing the correct diagnosis. The doctor may perform certain imaging assessments, for example optical coherence tomography (OCT), which provides them with a cross-sectional view of the retina. This type of imaging can diagnose a macular hole and can help differentiate it from another diagnosis that may appear similar, such as advanced macular degeneration (AMD). The eye doctor will ask about a person’s medical history, including any family history of eye conditions. Visual acuity testing, Amsler grid, and ophthalmoscopy are all performed to evaluate macula health and function. The retina doctor may also order photographs of the macula prior to performing surgery to repair the hole.

Treatment

Some macular holes seal spontaneously and require no treatment. Depending on the severity of the macular hole it is important that you seek advice on treatment options. In many cases, surgery is necessary to close the hole and restore useful vision. A vitrectomy is the most common treatment for macular holes. In this surgery, the surgeon removes the vitreous gel from inside the eye to prevent it from pulling further on the retina. The vitreous gel is then replaced with a mixture of gas and air. The air/gas bubble puts pressure on the edges of the macular hole encouraging it to heal. Another surgical technique commonly used for full thickness macular holes is internal limiting membrane (ILM) peeling in conjunction with a vitrectomy. Research has shown the combination of these surgical techniques has reduced the “face-down” time patients much observe following a vitrectomy, and also promotes a significantly better healing process of the macular hole. Individuals who have had a macular hole in one eye have a higher chance of developing a macular hole in the other eye at some point in their life. General eye check-ups are therefore important for people living with a macular hole. These individuals may still be at risk of developing other kinds of eye problems that affect the general population too, some of which may be treatable. No matter what level of vision a person may have, it is important to look after the eyes. To find out more about what can be done to take care of the eyes on a daily basis, please visit our Tips for Good Eye Health. For further information, please contact the Research Department on 01 6789004 or email research@fightingblindness.ie.

Research

Researchers continue to actively search for novel ways to treat macular holes. Investigational procedures assessing alternative surgical techniques and membrane plugs are ongoing. Information about clinical trials that are on-going and completed can be found on the clinical trials website and can be searched by both condition and location.

Support

Receiving a diagnosis can be overwhelming for anyone, but this is not a journey that you have to make alone. There are many groups and resources available to provide support for people living with Stargardt Disease. Fighting Blindness offers a free and confidential counselling service (Insight Counselling). For further information please contact insight@fightingblindness.ie or call 01 6746496. We also offer support groups for people with a visual impairment to share their feelings and experiences with others facing the same challenges. Please consult the support groups section of our website here to access the latest timings and days for the various support groups we offer. For further information please contact insightgroups@fightingblindness.ie or call 01 6746496.

Resources

Féach provides support for parents of children living with sight loss in Ireland. ChildVision is the national education centre for children with sight loss in Ireland. Vision Ireland, formerly NCBI (National Council for the Blind in Ireland) provides support and services for people living with sight loss in Ireland. Irish Guide Dogs for the blind helps individuals and their families to achieve improved mobility and independence.