Macular Hole

Photograph of a macular hole between the arrows.

Cross section of an optical coherence tomography (OCT) image of a macular hole before surgery.

Cross section of an optical coherence tomography (OCT) image of a macular hole before surgery.

The same patient after surgery, the macular hole is closed.

Another patient, cross section OCT image of a macular hole before surgery.

The same patient after surgery, the macular hole is closed.

The macula refers to the central part of the retina, or the nerve tissue in the back of our eyes, responsible for central vision and fine detailed visual tasks. The macula can develop a hole in the sixth through eight decades of life, or sooner in eyes that are near-sighted or have experienced trauma. Patients experience a central blind spot in their vision, and visual acuity in the clinic is typically in the 20/200 to 20/400 range. 

In most patients with macular hole, the hole develops spontaneously due to tractional forces exerted on the retina during normal age-related separation of the vitreous jelly that fills the largest cavity in the back of the eye. In other words, a patient's lifestyle or actions in most cases had no causal relationship on the development of the macular hole. Approximately 12% of patients develop a macular hole in both eyes. 

Full-thickness macular holes are treated with vitrectomy surgery (see surgeries section above). Success rates for hole closure after surgery have been reported in the 90% range. Visual acuity can improve by two lines or more.