The macula is the central part of the retina that provides us with best vision. The hole is usually created without apparent reason when the vitreous pulls away tearing off a small piece of the retina in the macula. In rare occasions, it may be caused by trauma of the eye, or due to other reasons.
Idiopathic holes usually present in older ages (over 65) and 10% of patients present with macular holes in both eyes. Unilateral disease has a 10% probability to present in the other eye within the following 5 years.
Macular holes are classified in five stages (0-4), by size and relation of the vitreous to the macula. Generally, the greater the stage, the worse the eyesight.
The patient experiences the hole as a blurring of vision in combination with distortion of the objects and, in more advanced stages, as a black shadow in the center of the eye.
When the disease affects the sight only in one eye, it may go unnoticed by the patient as the decreased vision in one eye is compensated by the good vision of the other eye (overlapping visual fields). Therefore, the problem is discovered either after a random eye examination or when the patient for any reason whatsoever decides to test the eyesight of each eye separately.
If the hole is left untreated, vision will progressively decrease, and at the end central vision will be lost and only peripheral vision will remain. In a few cases, small stage holes may close spontaneously.
There are two options for the correction of holes. The use of a special drug administered through an injection to the eye, which is recommended in small stage holes and surgery.
The injection is quick and painless. After the injection, the patient may experience some disturbances in their vision, such as flashes and floaters, while the drug acts inside the eye. The result of the injection is examined after about 4 weeks. If the injection has failed, the patient can still undergo surgery.
The operation to correct the hole takes about 30-40 minutes, it is performed as a same day case and the patient returns home with the eye covered for 24 hours. After the operation, the patient should avoid the supine position for a week and should use drops for about 4 weeks. At first, eyesight is poor due to the presence of a special gas in the eye which is gradually absorbed by the blood stream.
The operation’s success rate depends on the chronicity and the size of the hole and in most cases, it is over 90%. Once the hole closes, the vision will improve over a period that extends between many weeks to many months.
The decision for surgery will depend on the hole’s characteristics, the patient’s needs and the condition of the other eye.
Secondary holes are treated depending on their cause, while a consultation with a specialized vitreous surgeon may be required.