A macular hole is a small break in the macula, which is 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.
A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.
In order to understand a macular hole, it is helpful to understand the parts of your eye involved with sight. These structures include the cornea, iris, pupil, lens, macula, and retina.
Your cornea is a thin, clear layer on the outside of your eye. The iris, or the colored part of your eye, is a muscle that controls the amount of light going through your pupil -- the round opening in the center of your eye. Behind the iris sits the lens, which is just larger than your pupil. The iris is enclosed by a thin, clear capsule that holds the lens in its proper place.
When light enters your eye, the cornea and lens form the light rays into a beam of light that is focused directly onto your retina, the light-sensitive tissue at the back of the eye. The retina instantly converts light, or an image, into electrical impulses. The retina then sends these impulses, or nerve signals, to the brain through the optic nerve. The optic nerve is a bundle of more than one million nerve fibers connecting the retina to the brain.
The macula is located in the center of the retina. It is made up of millions of light-sensing cells that help to produce central vision.
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.
Macular Hole Versus Macular Degeneration
A macular hole and
macular degeneration are not the same things. Macular holes and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar. Both conditions are common in people age 60 and over. An eye care professional will know the difference.
The cause of a macular hole can be the result of:
- The vitreous pulling on the retina
- Certain eye conditions.
Risk Factors for Macular Holes
Macular holes can be associated with various eye conditions. While not a specific cause of macular holes, these eye conditions increase a person's chance of developing a macular hole. These are known as macular hole risk factors. They include some of the following conditions:
There are three stages to a macular hole based on its size, location, and severity:
- Foveal detachment (stage I)
- Partial-thickness hole (stage II)
- Full-thickness hole (stage III).
Symptoms of Macular Holes
Macular holes often begin gradually. The severity of
macular hole symptoms will depend on the size of the hole and its location on the retina.
Symptoms of a macular hole can include the following:
- Slight distortion or blurriness in straight-ahead vision
- Straight lines or objects look bent or wavy
- Increased difficulty with reading and performing other routine tasks with the affected eye
- Loss of most central and detailed vision.
In the advanced stage of a macular hole, a person can develop a
detached retina, which is a sight-threatening condition that should receive immediate medical attention.
These possible macular hole symptoms are not always a sure sign of a macular hole. Other conditions can cause these symptoms. If you have possible macular hole symptoms, you should see your healthcare provider so that the problem can be diagnosed and treated as quickly as possible.
Diagnosing a Macular Hole
In order to make a macular hole diagnosis, your doctor will ask you a number of questions about your medical history and will perform a comprehensive eye exam that includes dilation.
Although some macular holes can seal themselves and require no macular hole treatment, surgery is necessary in many cases to help improve vision. The surgery used for macular hole treatment is called a
vitrectomy.
Vision improvement varies from patient to patient following macular hole surgery. People who have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period.
If a macular hole exists in one of your eyes, there is a 10 to 15 percent chance that a macular hole will develop in the other eye over your lifetime. Your doctor can discuss this with you.
Possible risks of surgery for a macular hole include but not are not limited to:
Other Names Used for a Macular Hole
Other names that can be used to describe a macular hole include:
- Macular cyst
- Retinal hole
- Retinal tear
- Retinal perforation.
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