Vision in the center of where you focus can become blurry and distorted.
The macula where the hole develops, is a very small spot in the center of the back of the retina. Light focuses to a sharp point at the macula, which is the only area of the eye that sees crystal clear, color vision (such as for driving or recognizing faces).
Macular holes often are related to aging processes, they are more likely to develop if you are over age 60. Also, women have a slightly higher risk for macular holes than men.
Older people are more likely to develop macular holes, which form in the inner back portion of the eye (retina) in the macula, where fine focusing occurs.
Macular holes, tears and cysts are not the same as another age-related macular degeneration which also occurs more frequently among those over age 60.
Macular holes can occur due to:
- Vitreous shrinkage and/or separation
- Diabetic eye disease
- High amounts of nearsightedness
- Macular pucker
- A detached retina
- Best’s disease (inherited condition causing macular damage)
- Eye injury
Macular Hole Caused by Vitreous Shrinkage and/or Separation
The back of your eye is filled with a rather thick, gel-like material called the vitreous humor (also called the vitreous body or the vitreous) that helps your eye keep its shape. The clear vitreous shrinks and becomes more liquid with aging
Because the vitreous is attached to the retina with tiny strands of cells, it can pull on the retina as it shrinks. Sometimes, this shrinkage can tear off a small piece of the retina, causing a hole. If this missing piece of retina is in the macula, it’s called a macular hole.
Another direct cause of macular holes due to vitreous shrinkage is when the strands stay attached to the retina and break away from the vitreous. These strands can contract around the macula, causing the macula to develop a hole from the traction.
In either case, fluid develops where the vitreous shrinks to fill the spaces. This fluid can seep into a macular hole, causing blurred and distorted vision.
Macular Hole Surgery and Repair
A vitrectomy is the most common treatment for macular holes. In this surgery, a retinal specialist removes the vitreous gel to stop it from pulling on the retina.
Dr. Brooks pioneered the technique of the removal of the internal limiting membrane (ILM) which greatly increases the success of surgery >98% and decreases the time of face down positioning after surgery. All the doctors at Southern Vitreoretinal Associates perform ILM peeling with macular hole repair.
Then the specialist inserts a mixture of air and gas into the space once occupied by the vitreous.
This bubble of gas puts pressure on the edges of the macular hole, allowing it to heal.
While the bubble is doing its job, you will be face down during the day and sleep on either side at night for 5 days. The gas bubble gradually goes away over time, and natural eye fluids take its place while the hole is healing.
Risks of vitreous surgery include infection and retinal detachment, both which are treatable. The most common risk, however, is cataract development. Cataracts usually occur rather quickly after a vitrectomy, but they can be removed once the eye has healed.
If you have had surgery for a macular hole using a gas bubble, you won’t be able to travel by air for several months, because the gas can expand with pressure changes, causing eye damage.
People who have had a macular hole in one eye have a higher chance (about 10 percent) of developing a macular hole in their other eye at some time in their life.