What Causes a Macular Hole?

The interior of the eye is filled with a gel-like substance known as vitreous fluid. The vitreous fluid of the eye helps maintain its round shape and contains fine fibres that are attached to the surface of the retina.

With age, the vitreous fluid naturally shrinks and pulls away from the retina. Natural fluids will then fill the areas where the vitreous fluid has contracted. This is normal among people over the age of 50 and many experience no adverse effects however some do experience harmless symptoms such as the presence of floaters which are little specks that float in your field of vision.

However, in some cases, the pulling away of the vitreous fluid from the retina can cause a macular hole. The natural fluids that fill the areas where the vitreous fluid has contracted seep through the hole and onto the macula which leads to blurred and distorted vision.

Although age may be the primary risk factor of contracting a macular hole, macular holes can also occur among people who have sustained injuries to the eye and eye disorders such as macular pucker, myopia (nearsightedness), and retinal detachment.

Symptoms of a Macular Hole

Patients diagnosed with a macular hole may experience slight blurriness and distortion in their vision. Other symptoms include difficulties performing everyday tasks and the perception of straight lines appearing bent or wavy.

Stages of a Macular Hole

There are three stages to a macular hole:

• Stage I (foveal detachment) – The fovea (an area of the retina) detaches
• Stage II (partial-thickness hole) – A macular hole is defined by a full thickness break. In stage II, a partial-thickness hole occurs
• Stage III (full-thickness hole) – A full-thickness break occurs in the fovea

The location of the hole as well as the size of it determines how much of the patient’s vision is affected. In stage III macular hole, most detailed and central vision is lost. If a macular hole is left untreated, it can lead to retinal detachment which is an eye condition that can cause permanent vision loss.

Diagnosing a Macular Hole

Our ophthalmologists at Subang Jaya Medical Centre’s (SJMC) centre will first dilate your pupil with the use of eye drops which allows for a clearer look at the inside of the eye using a special lens. An Optical Coherence Tomography (OCT) will be used to observe the retina at a microscopic level. An OCT helps confirm the diagnoses and allows our ophthalmologists to capture photographs of the retina in which the size of the macular hole can then be measured. Along with the size, our ophthalmologists will be able to predict the stage of the macular hole and the outcome of the treatment that is to be prescribed.

Treating a Macular Hole

Some macular holes can heal by themselves with no treatment required, however in most cases, a vitrectomy which is a form of eye surgery may be required to seal the macular hole.

A vitrectomy involves the removal of the vitreous fluid from the eye to prevent it from further pulling away from the retina. The area is then replaced with a bubble that contains a mixture of air and gas. The bubble acts as a temporary bandage that holds the macular hole in place as it heals.

A patient who undergoes a vitrectomy is required to remain in a face-down position post-surgery for a period advised by the ophthalmologist. The face-down position allows for the bubble to push against the macula as it gradually gets absorbed by the eye. Once the bubble is reabsorbed, the vitreous cavity is naturally filled with natural eye fluids.

Early Detection Through Routine Eye Screenings

Early detection of a macula hole can prevent the condition from worsening. Undergoing routine eye screenings is important in caring for your eye health. At Subang Jaya Medical Centre (SJMC), we urge everyone, especially the elderly to frequently visit an ophthalmologist for routine eye screenings.

Routine eye screenings can help your ophthalmologist detect and treat eye conditions before it worsens. Our experienced ophthalmologists and eye surgeons at SJMC Eyecentric have undergone years of training and practise in the field of ophthalmology, diagnosing and treating a range of eye conditions. Our patients are cared for using a holistic approach, from diagnosis to prevention.

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