The macula is the center of the retina tissue that lines the back of the eye. The macula is needed for central vision and allows us to see details and things that are straight ahead. A macular hole is a small tear in the center of the macula. Macular holes are most common in people over the age of 60 and are caused by an abnormal pulling on the central macula by the vitreous. These holes can also be a result of eye injury, though this is not as common.
As part of the aging process, the vitreous jelly inside the eye starts to pull away from the retina and macula. However, in some patients, the jelly is adhered tightly to the macula for no apparent reason. As the jelly pulls away, the adhered portion sticks to the macula causing a tear or “hole”. Severe loss of vision can occur.
To treat the hole, surgery is used to remove the vitreous gel and remove a tight layer from the surface of the macula. The eye is then filled with a gas, which acts as a splint. After surgery, patients must lay in a facedown position for many days. This allows the gas bubble to “push together” the edges of the hole located in the center of the back of the eye. With correct patient positioning, the gas bubble holds the retinal tissue in place, while the hole heals. After several weeks, the bubble dissolves on its own. There is always a risk of non-closure of the macular hole even with surgery.
Some amount of permanent vision loss is usually associated with the formation of a macular hole. Even with successful closure of the hole, vision may not improve. However, vision usually improves over time, once the hole has closed.