Macular Hole Information
Some of the questions and answers people often ask about eye problems especially regarding eye problems after surgery. This page deals with frequently asked questions relating to Macular hole or macula hole
What is a macular hole?
The macula is part of the retina. The retina is the light sensitive membrane in the eye. In many ways, it is similar to the film in a camera. The macula is the part of the retina with which you are reading this text. It is at the very centre of the retina the part of the retina that provides you with the most sensitive vision. A macular hole occurs when the macula splits at its centre. It is caused by the jelly within the eye (the vitreous) pulling on the macula.
A macular hole occurs when the macula splits at its centre. It is caused by the jelly within the eye (the vitreous) pulling on the macula.
Is this macular degeneration?
No. A macular hole is not a feature of macular degeneration.
Who gets macular holes?
Macular holes most often occur in patients who are between 60 and 80 years old. Two ladies are affected for every man that gets the problem and we are increasingly aware of the fact that it is mainly longsighted people who get them. Some other groups of patients also get macular holes. These can include people who have severe injury to the eye, people who are very shortsighted and some people who have undergone a retinal detachment repair.
How does a macular hole affect your vision?
Macular holes tend to affect one eye at a time. Many people with a macular hole are however very aware that the poorer eye interferes with, or "gets in the way" of the better eye. As a result, even though the hole only affects one eye, the vision with both eyes open can be very unsettled. Some people go as far as covering, or closing one eye, in order to get over this effect.
What happens to a macular hole, if it is not treated?
The good news is that about 1 in 8 macular holes will disappear on their own without any treatment. In these circumstances, the vision returns almost to normal.
7 out of 8 macular holes unfortunately, do not go away on their own. In these circumstances, the vision tends to deteriorate. This deterioration only affects the very central part of the vision. Macular holes only affect the central part of the vision and, as such, patients suffering from macular holes do not go blind. After two or three years, however, they would be unable to see the newsreader's face on television, or read even the largest print on the eye test chart, from a distance of two metres.
Can I develop a hole in my other eye?
About 1 in 10 people who develop a macular hole in one eye, will develop a hole in the other eye. There are some circumstances in which we are able to say that the development of a hole is very unlikely to occur in the other eye. This relies on the result of an examination of the vitreous jelly within the eye.
What happens to a hole if it is treated?
Most people who choose to undergo macular hole surgery are pleased with the result. Between 80% and 90% of macular holes can be successfully treated with an operation. Success means that the hole is closed. In visual terms, this is usually associated with an improvement in vision.
That improvement tends to be maintained. It should be remembered that an untreated hole tends to get worse. Most patients who undergo a successful macular hole operation are able to read two or three more lines on the standard vision test chart. A major benefit, in addition to improvement and stabilisation of the vision, is that the distortion tends to be much less after surgery. The other major benefit is that the eye with the hole tends to interfere or get in the way of the other eye ater a successful operation. If the first operation fails then it can be done again.
Are there any complications of macular hole surgery without face down posturing?
Unfortunately, there are four major complications of macular hole surgery. However only about 1 in a 100 patients would be expected to be significantly worse as a result of undergoing macular hole surgery.
1) Failure
Failure to close the hole will occur in about 1 in 2 out of 10 patients. In most circumstances, it is possible to have another go at surgery. If the hole fails to close, then the vision tends to be a little worse than it was prior to the surgery.
2) Cataract.
A cataract will develop in virtually everybody who undergoes macular hole surgery that has not already had a cataract operation performed. This complication is so common that I now routinely perform cataract surgery as part of a macular hole operation. This does not appear to affect either the success or complication rate and stops the patient from having 2 operations over 2 years.
3) Retinal detachment
Retinal detachment. Retinal detachment will occur in about 1 in a 100 people undergoing a macular hole operation. The vast majority of retinal detachments are repairable, but this can potentially be a blinding complication and surgery is needed to repair the detachment.
4) Infection.
Infection will occur in about 1 in every 500 patients who undergo a macular hole operation. This tends to occur in the 2-5 days after the operation. If caught early enough, then most infections within the eye can be treated successfully. Unfortunately, infection can be a devastating complication of surgery. Overall, less than 1% of patients could expect to end up worse after macular hole surgery.
5) Glaucoma.
Raised pressure may occur in an eye that has undergone a vitrectomy. In most cases this can be successfully treated without any harm coming to the eye. In a very small proportion of patients there may be sight threatening damage to the eye as a consequence of high pressure.
