What is a macular hole?

Is a macular hole the same as age-related macular degeneration?

What causes a macular hole?

What are the symptoms of a macular hole?

Are there different types of a macular hole?

How is a macular hole different from a macular pucker?

 

Eye Anatomy

List of Diseases

 

Information provided courtesy of the
National Eye Institute, US National Institutes of Health

 
 

Macular Hole


What is a macular hole?

A macular hole is a small break in the macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.

macular hole

A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.

 


Is a macular hole the same as age-related macular degeneration?

No. Macular holes and age-related macular degeneration (AMD) are two separate and distinct conditions, although the symptoms for each are similar. Both conditions are common in people 60 and over. An eye care professional will know the difference.

 


What causes a macular hole?

Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most cases, there are no adverse effects. Some patients may experience a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.

However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Also, once the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula, blurring and distorting central vision.

Macular holes can also occur from eye disorders, such as high myopia (nearsightedness), macular pucker, and retinal detachment; eye disease, such as diabetic retinopathy and Best's disease; and injury to the eye.

 

What are the symptoms of a macular hole?

Macular holes often begin gradually. In the early stage of a macular hole, people may notice a slight distortion or blurriness in their straight-ahead vision. Straight lines or objects can begin to look bent or wavy. Reading and performing other routine tasks with the affected eye become difficult.

 


Are there different types of a macular hole?

Yes. There are three stages to a macular hole:

  • Foveal detachments (Stage I)
    Without treatment, about half of Stage I macular holes will progress.

  • Partial-thickness holes (Stage II)
    Without treatment, about 70 percent of Stage II macular holes will progress.

  • Full-thickness holes (Stage III)

The size of the hole and its location on the retina determine how much it will affect a person's vision. When a Stage III macular hole develops, most central and detailed vision can be lost. If left untreated, a macular hole can lead to a detached retina, a sight-threatening condition that should receive immediate medical attention.

 


How is a macular hole different from a macular pucker?

A macular pucker and a macular hole are different conditions, although they both result from the same pathological process: the pulling on the retina from a shrinking vitreous. When the "pulling" causes microscopic damage, the retina can heal itself; scar tissue, or a macular pucker, can be the result. If the shrinking vitreous pulls too hard, it can tear the retina, creating a macular hole, which is more serious. Both conditions have similar symptoms – distorted and blurred vision. Also, a macular pucker will not "develop" into a macular hole. An eye care professional will know the difference.