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

These 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 one, the macular hole in eye causes, and the treatment options that 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. This means that there is no clear apparent cause for the ailment. 

However, there are some well-established causes for it too, including the following:

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

Aside from that, there are some other risk factors that put patients at risk of macular holes: age, high myopia, and being a woman.

Risk factor 1: Age

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. In the early stage of this process, the retina usually has enough elasticity to cope with the pulling.

Over time, however, the physical stress may eventually lead to damage that becomes a tear in it – or a macular hole.

Risk factor 2: High myopia

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. Due to this, they may be thinner than normal from the start. This can obviously raise the chances of a hole forming.

Risk factor 3: Being a woman

Interestingly, women are also more likely than men to get macular holes. Some studies have noted the ratio for female-to-male incidence to be as high as 3.3 to 1.

Unfortunately, the reason for this is unknown at the moment. Studies are ongoing.

Macular hole stages of development

Macular holes may be found at different stages of development. The severity of a hole will usually depend on the size it is found to be during eye examinations.

Foveal detachment or cyst

This is the first stage and has the mildest (often nearly undetectable) symptoms. Sometimes, it is called a macular cyst instead. It involves very minor damage to the central part of the retina.

Impending macular hole

At this stage, the macula has already developed a small hole, so symptoms begin to appear. Your central vision may be blurred or distorted by now. Some people even report it to the point where they start noting issues with reading.

Full-thickness hole

At this stage, the hole is fully developed. In other words, it extends through the entire thickness of the macula. Symptoms are pronounced and surgical macular hole repair is often needed.

Full-thickness hole with posterior vitreous detachment

A macular hole can occasionally come with a complete posterior vitreous detachment or PVD. This means in addition to the hole, the eye’s vitreous gel has completely separated from the macula. This is considered 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 closing up by themselves. However, most will require treatment in the form of surgery.

The procedures used for macular hole repair are vitrectomy surgeries. They involve the removal of the vitreous gel from the eye. 

This is usually followed by peeling off a thin layer of tissue around the macular hole. The surgeon then follows that with an injection of a gas bubble into the eye. 

Sometimes, after the surgery, patients will be required to maintain a face-down posture for a few days. This is to keep the bubble in contact with the macula for as long as possible.

After that, patients generally need to go easy for 2 to 4 weeks after surgery. Doing this gives the eye time to heal properly.

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!