Macular Hole Treatment

Macula is the highly pigmented spot in the center of the retina. This retinal tissue is responsible for central vision (not peripheral vision), which is necessary for many activities, like, reading, driving, etc. A macular hole denotes a hole or a break in the macula and results in distorted or blurred vision, which may lead to total loss of central vision, if left untreated. Usually this condition is age-related and is commonly seen in people above the age of sixty. Macular hole is different from macular degeneration and is also known as retinal hole, retinal perforation, retinal tear or macular cyst.

A macular hole is caused by the shrinkage of the vitreous, a jelly-like substance, that fills the eye. Almost 80 percent of the eye is filled with this substance, which is helpful in maintaining the organ's round shape. The thin fibers of the vitreous are connected to the surface of the retina. Normally the vitreous is firmly attached to the retina but as a person ages, the vitreous becomes thinner, which causes its shrinkage and separation from the retina. This separation or pulling away from the retina results in a hole in the macula, causing a macular hole. The macular hole or void gets filled with natural fluids, which cause disturbances in the vision of some affected people. The shrinking of vitreous sometimes leaves some fibers on the retina itself. These fibers may contract and the tension arising from this may lead to a hole in the macula. In some people, macular holes can be formed due to eye diseases, like, high myopia, diabetic retinopathy, Best's disease or some injury or trauma to the eye.

Macular holes develop gradually. During the initial stages, the affected person experiences blurred or distorted vision, which may later progress to more severe problems. There are three stages in the development of a macular hole. Stage I is termed as foveal detachment, stage II is known as partial-thickness hole and stage III denotes full-thickness hole. The severity of symptoms and the power of vision depends on the size and location of the hole. If not treated in time, a macular hole can lead to a detached retina, which in turn can result in total loss of vision. The common symptoms of a macular hole are blurred or distorted central vision, central blind spot or gray area.

Early detection is an important factor, as far as restoring the vision of the affected person is concerned. As of now, the only treatment option for a macular hole is surgery. This condition is rectified with a surgery called vitrectomy, which is performed under local anesthesia. Vitrectomy is done by removing the vitreous gel and replacing it with a bubble filled with air and gas. This helps to keep the macular hole intact, by holding its edges in place, until it heals. Post surgery, it is very important for the patient to keep his face down for some days. In some cases, patients are advised to maintain that position for two or three weeks. This position helps the bubble to press the macula and fill the hole. Gradually, this bubble is absorbed by the body and the natural eye fluids fill the vitreous cavity.

The most common side-effect of this surgical treatment is development of cataract. Others include infections and retinal detachment, which can happen either during surgery or after that, but they are curable. It is also very important for the people, who have undergone vitrectomy, to avoid air travel. The changes in air pressure can cause problems with the installed bubble.

As stated above, for macular hole treatment, early detection is very crucial and those who are detected with this condition within six months of its development, have better chances of vision recovery than others. In some patients, the macular hole may seal naturally, but surgery is still necessary to restore vision. It is also observed that people who have macular hole in one eye, have chances of developing this condition in the other eye too. Regular visits to an ophthalmologist would be beneficial to catch this problem early and carry out the treatment for restoration of vision.