Macular hole
A macular hole is a small gap that opens at the centre of the retina (back of eye), in an area called the macula. If you have blurred or distorted vision, or a black spot in the centre of your vision, see your GP or optician as soon as possible.
About macular hole
The retina is the light-sensitive film at the back of the eye.
In the centre is the macula – the part responsible for central and fine-detail vision needed for tasks such as reading.
In the early stages, a macular hole can cause blurred and distorted vision.
Straight lines may look wavy or bowed, and you may have trouble reading small print.
After a while, you may see a small black patch or a "missing patch" in the centre of your vision.
You won't feel any pain and the condition doesn't lead to a total loss of sight.
Surgery is usually needed to repair the hole.
This is often successful, but you need to be aware of the possible complications of treatment.
Your vision will never completely return to normal, but it's usually improved by having surgery.
Cause of a macular hole
It is not known why macular holes develop. The majority of cases have no obvious cause.
They most often affect people aged 60 to 80. They are more common in women than men.
One possible risk factor is a condition called vitreomacular traction.
As you get older, the vitreous jelly in the middle of your eye starts to pull away from the retina and macula at the back of the eye.
If some of the vitreous jelly remains attached, it can lead to a macular hole.
A few cases may be associated with:
- retinal detachment – when the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients
- severe injury to the eye
- being slightly long-sighted (hyperopic)
- being very short-sighted (myopic)
- persistent swelling of the central retina (cystoid macular oedema)
When to get medical advice
If you have blurred or distorted vision, or there's a black spot in the centre of your vision, see your GP or optician as soon as possible.
You'll probably be referred to a specialist in eye conditions (ophthalmologist).
If you do have a macular hole and don't seek help, your central vision will probably get gradually worse.
Early treatment (within months) may give a better outcome in terms of improvement in vision.
Sometimes the hole may close and heal by itself, so your ophthalmologist may want to monitor it before recommending treatment.
Treatment for a macular hole
Vitrectomy surgery
A macular hole can often be repaired using an operation called a vitrectomy.
If you need surgery, the surgeon looking after your care will explain the different stages of the procedure with you and what to expect after the operation.
The operation is successful in closing the hole in around nine out of 10 people who've had the hole for less than six months, and six out of 10 people who've had the hole for a year or longer.
Even if surgery does not close the hole, your vision will usually at least become stable, and you may find you have less vision distortion.
In a minority of patients, the hole does not close despite surgery, and the central vision can continue to deteriorate. A second operation can still be successful in closing the hole.
Injection
In certain circumstances, it may be possible to treat a macular hole with an injection into the eye.
The injection helps the vitreous jelly inside your eye to separate from the back of the eye and allows the macular hole to close.
The injection is usually only available in the early stages the specialist managing your care will tell you if this treatment might work for you.
Post-treatment recovery
After any treatment, or surgery, the team looking after your care will advise you on how to best look after your eye, and what to expect as you recover.
Most people will need some time off work, although this will depend to an extent on the type of work you do and the speed of recovery.
Discuss this with your surgeon.
You probably won't be able to drive for six to eight weeks after your operation. Speak to your specialist if you're unsure.
Mild pain or discomfort
Your eye may be mildly sore after the operation and will probably feel sensitive.
Contact your ophthalmologist immediately or go to your nearest eye emergency department if:
- you're in serious pain
- your vision gets worse than it was on the day after the surgery
Developing a macular hole in your other eye
After carefully examining your other eye, your surgeon should be able to tell you the risk of developing a macular hole in this eye.
It's important to monitor any changes in the vision of your healthy eye and report these to your eye specialist, GP or optician urgently.
Age-related macular degeneration (AMD)
A macular hole is not the same as macular degeneration. Although the two conditions affect the same area of the eye and can sometimes both be present in the same eye.
AMD is damage to the macula leading to the gradual loss of central vision.
Getting older, smoking and a family history of the condition are known to increase your risk.
More useful links
The information on this page has been adapted from original content from the NHS website.
For further information see terms and conditions.