Usually a chance finding, a macular hole is a significant pathology and a race against the clock to treat. It is often discovered by closing the unaffected eye, with the sudden realisation that the centre of the picture is not there, or that letters are missing from a word.
If this has happened to you, read on. It could be a macular hole, a condition with a very good outlook when treated in time. Dr. Gurjeet Jutley, ophthalmologist at Clínica Guirao in Murcia, explains what it is, why it happens and how it is treated.
What is a macular hole?
The macula is the central area of the retina, measuring only a few millimetres in size. Despite this, it is responsible for fine vision, helping with tasks like reading, sewing, recognising faces or looking at your phone screen. At its centre lies the fovea, the sharpest point of vision in the eye.
A macular hole is a small break through the layers of the retina exactly at that point. It is tiny, usually less than half a millimetre, but it sits in the most valuable spot in the eye. Despite the similar name, it has nothing to do with age-related macular degeneration: they are different conditions with different treatments.
Why does it happen?
The inside of the eye is filled with a gel called the vitreous. With age, this gel shrinks and gradually separates from the retina. In most people this happens without consequences, but sometimes it stays attached at the centre of the macula and, as it pulls, ends up opening a small hole.
This is why macular holes are more common after the age of 60, with a slight propensity in women. They can also follow an eye injury or occur in people with high myopia. It is not caused by anything you did, nor by straining your eyes.
Symptoms: how to recognise it
The most characteristic symptom is a blurred, dark or completely empty area in the centre of your vision, while side vision remains normal. Many patients also notice that straight lines bend or narrow towards the centre, and that reading becomes increasingly difficult.
It rarely affects both eyes at the same time. That is why the healthy eye compensates for weeks or months, and the problem goes unnoticed until someone covers their good eye. Try it at home: cover one eye, look at a grid or your kitchen tiles, then repeat with the other. If you see a gap, a smudge or distorted lines in the centre, ask for an assessment.
How is it diagnosed?
Diagnosis is confirmed with optical coherence tomography (OCT), a test that takes a few minutes, is painless and does not touch the eye, and shows the retinal layers in high resolution. OCT measures the size of the hole and distinguishes it from similar-looking conditions, such as pseudoholes or lamellar holes, which often do not need surgery.
Is there a treatment?
Yes. In very early stages, some holes close on their own and monitoring is enough. When the hole is full-thickness, treatment is surgical: a vitrectomy. During the procedure the vitreous that was pulling on the macula is removed, the surface of the retina is released and the eye is filled with a gas bubble that gently presses the edges of the hole while it heals.
It is a day-surgery procedure under local anaesthesia with sedation. In recently formed holes, the closure rate is above 90%. The gas is absorbed naturally within a few weeks and the eye replaces it with its own fluid.
Recovery: what you should know
While there is gas in the eye your vision will be blurred, like looking through a water level that slowly drops. Flying is an absolute no whilst the gas is in the eye, as changes in altitude make the gas expand.
Vision improves gradually over weeks and months. If you have not yet had cataract surgery, it is common for a cataract to progress after a vitrectomy; this is expected and is resolved with cataract surgery when the time comes.
Why not wait?
The longer a macular hole stays open, the more it tends to enlarge and the less vision is recovered after closure. Holes operated on within the first few months achieve the best results. So if you notice any sudden change in your central vision, the sensible thing is to book an assessment as soon as possible.
Book your assessment in Murcia
Dr. Gurjeet Jutley trained at Moorfields Eye Hospital in London and was a consultant at Oxford University Hospital. Today he operates at Clínica Guirao, in central Murcia, so you do not need to travel outside the region. If you recognised yourself in this article, book an appointment and we will explain everything calmly.
