Formation of Macular Hole and its Treatment

The macula is a small oval portion on the centre of the retina made up of nerve cells. The macula is primarily responsible for detailed sharp and central vision. The direct vision that we use in order to read, work on a computer or sew is facilitated through the macula. Macular hole normally affects only one eye, but there is a one out of ten chance that the other eye will gradually be affected.

The cause of macular hole can be attributed mainly to aging, but in rare cases, it can develop due to some kind of trauma. As one gets old, the vitreous inside the eye changes form. It starts shrinking and moves towards the centre of the eye. In some individuals, the vitreous is firmly attached to the retina in the macular area. And as it shrinks, it pulls away from the back of the eye and can cause a small tear called macular hole.

The central part of the vision is affected by a macular hole. The changes in vision can affect viewing straight lines which will look wavy in the initial stages, while in the later stages the view can consist of a small patch in the centre vision. Trouble in reading small prints or distortion can be accompanied in the initial phases.

Symptoms of Macular Holes

The symptoms of a macular hole are: blurred or distorted central vision, wavy vision, difficulty in reading fine print details, appearance of grey area in central vision and blind spot in central vision.

The macular hole has many stages associated with it. These stages can be categorized according to the size of the hole and layers of the affected eye. In the early stages, a macular hole can be made to heal by itself. So an ophthalmologist can recommend monitoring the progress of a macular hole initially, before moving ahead with any kind of treatment. But in most of the cases, a macular hole once created, develops and distorts the vision. And in the final stages of a macular hole, the central vision is almost completely impaired.

Treatment

The treatment of macular hole depends upon the stage of vision impairment. Within six months of a macular hole initiation, ophthalmologists recommend a vision improvement therapy. This recovery program varies from patient to patient. In some cases significant recovery can be achieved, while in others only average or small amount of recovery is experienced.

For holes that deeply affect the macula, a surgical procedure called vitrectomy is mostly used. In this surgery, the vitreous is removed in order to stop its pull on the retina, and in its place a gas bubble is inserted, which gradually fills up with fluids. After the surgery, the patient is made to keep the face in a downward position for at least two weeks. This positioning allows the bubble to press against the macula in order to seal the hole. The bubble usually takes around 3 to 4 months to disappear completely. This surgery is almost 90% successful in treating macular hole. However, vision improvement varies from patient to patient. Research studies are being continuously carried out in order to treat macular hole using silicon oil instead of the air bubble.