Macular holes are small breaks in the macula, a part of the eye that is needed to see fine details.
These holes can be progressive, with four stages representing increasingly serious symptoms and lower chances of recovery. Symptoms can begin as blurriness and seeing straight lines as curvy, and they can get severe with time.
Among people who have a macular hole, 10 to 15 percent will develop one in the other eye later in life. (Learn More)
While some macular holes can heal on their own, always see a doctor if you have these symptoms.
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The most common way to treat a macular hole is with a vitrectomy, where the vitreous gel in your eye is temporarily replaced with a bubble of gas and air. This holds the macular hole in place and allows it to heal. (Learn More)
The chances of recovery decrease the longer you wait to seek help. Vision recovery rates from a macular hole are best for those who get help within six months of developing the condition. Even those at Stage III and Stage IV can often see significant recovery in vision with treatment, though they will likely not see total recovery. (Learn More)
The most common risk associated with this surgery is the development of cataracts, which will often need to be removed. Less common is the risk of infection or retinal detachment, which can be treated immediately if it occurs. Any surgery carries a small risk of serious error or other unforeseen complication. (Learn More)
Macular holes can cause serious vision problems, and they can get worse with time. Always get them checked by a doctor to understand your options and the proper course of treatment. (Learn More)
A macular hole is when there is a small break in the macula, a component of the eye that is important for seeing the fine details required for tasks like reading, driving, and more. It is a relatively common condition among people who are 60 and older, but it is a serious vision condition nonetheless that can lead to blindness or near blindness in the affected eye.
The condition can be progressive, getting worse with time, with three distinct stages.
- Foveal detachments (Stage I): If untreated, about 50 percent of Stage I holes develop into Stage II. At this stage, expect a slight distortion or blurriness in your straight-ahead vision. You may see straight lines as curved or wavy.
- Partial-thickness holes (Stage II): If untreated, about 70 percent of Stage II macular holes develop into full-thickness holes. At this stage, blurriness and visual distortions may become seriously detrimental to your ability to perform certain tasks.
- Full-thickness holes (Stage III): At this stage, prognosis for recovery becomes worse, although at least partial recovery is still possible for most patients. Your vision will be significantly affected, and tasks requiring you to see fine details will essentially be impossible with that eye.
- Further complications (Stage IV): At this stage, the posterior vitreous detaches and vision tends to be very bad in the affected eye (20/200 vision). The prognosis for recovery, even once treated, is now worse as well. Discuss your options with your doctor, as recovery is still possible even if total recovery is not.
While the exact mechanics of what is happening are complex, the advice to patients isn’t complicated. If you are experiencing symptoms similar to any of the above, seek help from a licensed professional. Hesitation will worsen your problem, and your chances at total or near total recovery will decline.
Additionally, 10 to 15 percent of patients who have had a macular hole in one eye can develop one in the other. Remain vigilant for such issues if you have already had a macular hole.
How Are They Treated?
Some macular holes may seal themselves, but never make the assumption that yours will. Always discuss your best course with a doctor.
In many cases, macular holes will be treated with a type of surgery called a vitrectomy. The vitreous gel in the eye is removed and carefully replaced with a bubble of air and gas. This stops the gel from pulling on the retina, and it holds the macular hole in place so it can heal. This is done under local anesthesia, meaning you will be awake but it should be fairly painless.
Once the procedure is done, you will have to lie face down to prevent complications for at least a day — sometimes for several days. Discuss the recovery process with your doctor.
There is research being done into a potential nonsurgical option for macular hole treatment. The viability of using currently experimental eye drops is being examined. However, progress is slow, and it is not yet known how effective they will be. Regardless, it may be a potential option in the future for some patients.
What Are the Chances of Recovery?
As with most things regarding vision, recovery from a macular hole will vary from patient to patient. Talk with your doctor to develop realistic expectations and properly understand the risk versus reward of any procedure you are undergoing.
Patients with the best chances of full recovery are those who seek help within six months of developing their macular hole. At this stage, the macular hole has not had time to progress too much, so the damage is less severe.
The longer you have had a macular hole, the more unlikely total recovery is. Even still, research has shown that there are fairly effective treatments for those with Stage III and Stage IV macular holes. While total vision recovery is unlikely, as much as 90 percent of patients can have their holes closed and see significant vision recovery.
Risks & Complications
Macular hole surgery carries a risk of triggering cataract development, often rapidly. If this occurs, it will often be severe enough that the cataract must be removed.
Less common is the chance of infection or retinal detachment during or after surgery. Both situations can be treated immediately.
There are also the risks associated with any surgery. Surgeons are doing precise work on your eye, and error could cause damage or blindness.
Patients cannot travel via airplane for a few months after their surgery. Changes in air pressure can affect the bubble in the eye, potentially leading to severe complications.
Is This a Serious Condition?
You should take the symptoms of a macular hole seriously. Failing to seek help for one could result in permanent damage to your vision.
Do not work under the assumption that you will be one of the people lucky enough to have their hole heal on its own. Get a trained professional to assess your particular situation.
Facts About Macular Hole. (April 2012). National Eye Institute.
Experimental Treatment for Macular Holes Opts for Eye Drops Over Surgery. (September 15, 2017). The University of Chicago Medical Center.
Idiopathic Macular Hole PPP 2019. (October 2019). American Academy of Ophthalmology.
A New Method of Treating Macular Holes. (April 2007). European Journal of Ophthalmology.
Revisiting Macular Holes. (February 15, 2007). Review of Ophthalmology.