There are certain eye ailments that can cause blurry or distorted central vision. One of these is the macular hole.

Macular holes are more common in women than men, as well as in those aged 55 or above. However, they can happen to anyone – and can affect a person’s ability to perform many everyday tasks.

If you worry that you may have one, read on as we explain  how to identify a macular hole and what treatment options are available.

What Is a Macular Hole?

The macular hole is a hole in the macula, or the central part of the retina. As a reminder, the retina is the layer at the very back of your eyeball.

The retina captures light and turns it into images for your brain via electrical signals. Hence, any damage to the retina will affect your ability to process images.

Since the macula is in the centre of the retina, this means  macular hole symptoms often appear as problems with the central part of your vision. The following are common symptoms:

• Blurry spots in your central vision
• Dark spots in your central vision
• Visual distortions like seeing straight lines as curved, wavy, or even broken

Macular Hole Causes and Risk Factors

Sometimes the causes for macular holes are idiopathic, meaning that there is no clear apparent cause. However, there are some well-established causes for macular holes. Including:

• Trauma to the eye
• Sun-gazing or staring at high-intensity laser lights

There are some other risk factors which put patients at risk of macular holes: age and high myopia.

Age is a common risk factor due to the changes in the eye as time passes. The vitreous gel that fills the eye and gives it the volume to maintain its round shape can shrink as we age.

When that happens, it can pull on the retina as it shrinks inwards. The physical stress of that pulling may lead to damage that becomes a macular hole.

High myopia (short-sightedness) is another common risk factor for a similar reason. Short-sighted people typically have an elongated eyeball.

This means their retinas are more stretched-out than others and may be thinner as a result. This can obviously raise the chanc- es of a hole forming.Interestingly, women are also more likely than men to get macular holes, but the reason for this is yet unknown. Some studies have noted the ratio for female-to-male incidence to be as high as 3.3 to 1.

Macular Hole Stages of Development

Macular holes may be found at different stages of development or severity:

Stage 1:
Foveal detachment or cyst
This is the first stage and has the mildest (often nearly undetectable, even) symptoms. Also called a macular cyst, it involves very minor damage to the macula.

Stage 2:
Impending macular hole
At this stage, the macula has already developed a small hole, so symptoms begin to be noticeable. Your central vision may be blurred or distorted to the point where you start noting issues with reading.

Stage 3:
Full-thickness hole
At this stage, the macular hole is fully developed: it extends through the entire thickness of the macula. Symptoms are pronounced and surgical macular hole repair is often needed.

Stage 4:
Full-thickness hole with posterior vitreous detachment
A macular hole can occasionally come with a complete posterior vitreous detachment or PVD, which means in addition to the hole, the eye’s vitreous gel has completely separated from the macula as an added complication.

Macular Hole Diagnosis

As with many other eye issues, diagnosis is best done early so that macular hole treatment options may be explored before the problem worsens.

Diagnosis typically begins with an eye exam. An ophthalmologist may elect to use these tests for easier identification of the problem:

• Dilated Eye Exam – This allows the doctor to examine your retina more easily.
• OCT or Optical Coherence Tomography – A non-invasive, radiation-free test that provides cross-sectional images of your retina.

Macular Hole Treatment

Very rarely, macular holes may have a chance of spontaneous closure. However, most will require intervention in the form of surgery.

The surgery done for macular hole repair is a vitrectomy. It involves the removal of the vitreous gel from the eye, usually followed by peeling of a thin layer of tissue around the macular hole, and concludes by injecting a bubble of gas into the eye. Sometimes after the surgery, patients will be required to maintain a face-down posture for a few days so that the bubble is in contact with the macula.

Get screened for macular holes at an eye centre today

Ultimately, our advice for those worried about macular holes is to seek eye screening promptly. Early detection and treatment can significantly improve outcomes and help preserve your vision.

Call us to enquire or book an appointment for macular hole treatment with our eye doctors today!

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