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Macular Hole

What is a Macular hole?A macular hole is a hole that is found in the macular which is a certain part of the retina. This part of the retina is the one that is responsible for carrying out activities that require detailed vision. This includes activities such as watching television, knitting, reading, driving or any other close work. It is a form of mechanical defect and is referred to as idiopathic which simply means that nobody knows for sure why certain people get the hole.
How do People Get it?As we grow older a lot of things happen. The vitreous jelly which fills the back of the eye shrinks and in some very rare cases about 1 in 3300, the jelly which is shrinking may pull out a piece of the retina from the part where the macular is located. At times the hole may be as thick as the retina. Nobody has ever really known why certain people develop this condition but it has been known to affect people in their old age. The condition is more common in women. There is a very high chance that you never did anything to cause the hole and it just occurred.

Symptoms of a Macular Hole

You will probably have noticed that things were not quite as they were supposed to be with your eye. You probably had difficulties watching the television or reading; lines that used to appear straight now appear wiggly, colors on one eye may not be as bright as with the other eye and people’s faces may appear distorted. All these symptoms show that you have a problem with your macular. Your ophthalmologist will use special equipment to make their diagnosis. A thin beam of light will be shone into your eye by the doctor and if you happen to have a macular hole, there may be a narrowing in the beam of light or a bit may be missing completely. If this is the case then that is a sign that the macular hole is present.
What Happens next?After that you will most certainly be referred to a vitreo surgeon so as to find out more about the operation. He will also assess you. When you are going home, you will have dilating drops put in your eyes. This is to ensure that you arrive home safely after your appointment with the surgeon.

Macular Hole Treatment

For a macular hole the standard form of treatment is an operation referred to as vitrectomy. During this operation, the surgeon will remove the vitreous jelly from the back of your eye. He will do this while you are under general or local anaesthetic and the vitreous cavity will be filled with some special gas bubble. When the operation is over, at times the patient will be asked to posture himself in a face down position. The gas bubble will float up and it will flatten the retina at the point where the macular hole is located and it will seal it.

For maximizing their chances of better vision and sealing the hole, some patients may have to posture their face parallel to the floor for up to 2 weeks for 50 minutes every 1 hour so as to make sure that the bubble floats in the right place against your retina. The surgeon is the one who will tell you whether it is necessary for you to posture. ( In some instances the removal of the membrane around the hole reduces the need for you to posture.)

This operation when combined with posturing could really help improve your vision in several different ways. Firstly, though this will depend with how long the hole has been present (the shorter the period, the better) your vision may be sharper. This means that you will now be able to read one or two more lines from the vision chart. Secondly, you may find that the distortion of straight lines and the size of the central defect may become less. However, you will find that in some cases there may be no improvement in vision. This is particularly true when the hole has been there for long.

What Will Happen If Nothing is Done? The hole may become bigger till a certain point where it will seem like you have a thumb held in front of you. Don’t wait till it becomes an irreversible condition, call us today!

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