When round breaks develop in your retina, the condition is called retinal holes. If such a hole happens to be in the center of your retina (in the macula) we call it a macula hole (MH). The macula is the part of your retina responsible for high definition central vision. Therefore a MH is usually associated with significant decline in vision and distortion of images. The condition is completely painless. If you develop such symptoms you should contact us and book an appointment with a retina specialist for evaluation. There are many causes for MH. The most common is related to degenerative changes of the jelly material that fills the inside of the eye (called the vitreous). As you age, the vitreous shrinks and pulls away from your macula. If the pull is associated with traction at the edges of the macula, it can cause a MH.
If you develop a MH, your retinal specialist will be able to detect it on exam and with retinal imaging tests. Depending on your age, the severity of your condition, your visual needs and your tolerance for procedures, a treatment plan will be discussed with you. Not all patients with MH require the same intervention. Different patients may require different treatment plans. However, the aim of any treatment plan is the same: improvement of vision. Our retina specialists will work with you towards the best treatment plan that fits your specific condition. If your eyesight is threatened, expert care from a trusted leader is your safest path to saving your sight.

During your evaluation, the ophthalmic technician will measure your visual acuity using a vision chart. This helps us determine how well you see for distance. Then the technician will dilate your pupil using dilating eye drops in order for the retina specialist to be able to examine your retina fully. Using special light sources and condensing lenses, your physician then examines the inside of your eye. In addition, an optical coherence tomography (OCT) is obtained to assess the MH and measure its size. The OCT allows us to obtain a cross sectional views of the macula with three-dimensional images. It is important for treatment planning and for monitoring treatment outcomes.

Treatment options:
Most macular holes can be repaired successfully. If there is no contraindication for it, the main stay of treatment for MH is surgery. The surgical technique is a procedure called vitrectomy during which we enter the inside of the eye cavity and remove the vitreous. Special small instrumentation is utilized for this surgery. At the end of surgery, we fill the inside of the eye with a gas bubble that gradually resorbs on its own after surgery and is replaced by normal eye fluids. The aim of the bubble is to splint the MH and allow for permanent healing, which persists even after the bubble resolves. On average, the bubble takes anywhere between 2-8 weeks to resolve. To aid your healing, your retina specialist may ask you to remain in a face down position for one week after surgery. This allows the bubble to press against the macula and keep it dry, which allows for better healing of the MH.
This surgery is technically delicate but very successful when performed by retina surgeons. Not all ophthalmologists are retina surgeons and specialists. Make sure an ophthalmologist specialized in retina surgery takes care of your condition.