A macular hole is a small break in the tissue at the centre of the macula, the area of the retina responsible for clear central vision. It can cause blurred or distorted central vision and usually occurs in older adults. Early diagnosis is important, as surgical treatment is required in most cases.
Condition · Vitreoretinal Surgery
Macular hole
A small hole affecting central vision
Overview
Symptoms
Symptoms depend on the size and stage of the macular hole. They may include blurred or distorted central vision, difficulty reading or seeing fine details, and the appearance of a dark or blurred area in the centre of the visual field.
Risk factors
Risk factors associated with macular hole include increasing age, female sex, high myopia, previous ocular trauma, and a history of macular hole in the fellow eye. Other retinal conditions and previous vitreoretinal surgery may also increase the risk. In most cases, however, no specific underlying cause can be identified.
How is it diagnosed?
Diagnosis of a macular hole is based on a comprehensive eye examination and macular OCT. OCT provides detailed images of the retinal layers, allowing accurate confirmation of the hole, assessment of its size and stage, and evaluation of any associated vitreous traction.
Treatment
Small or early macular holes may sometimes be monitored, as some can close spontaneously.
For a full-thickness macular hole, particularly when vision is affected, vitrectomy surgery with peeling of the internal limiting membrane (ILM) is usually recommended. A gas bubble is commonly placed in the eye to help the hole close. The visual outcome depends on factors including the size and duration of the hole.
When to seek an assessment
If you notice new or progressive blurring or distortion of your central vision, particularly if straight lines appear wavy or you notice a dark area in the centre of your vision, it is important to have an eye examination. OCT helps with early diagnosis and assessment of the severity of the macular hole.
If you have been diagnosed with a macular hole, discuss the most appropriate treatment with a specialist vitreoretinal surgeon, based on your symptoms and OCT findings.
Key points
- A macular hole is an opening in the centre of the retina affecting detailed central vision.
- It commonly causes blurred or distorted central vision.
- OCT is the key test for diagnosis and determining the stage of the hole.
- Vitrectomy surgery can successfully close most full-thickness macular holes and improve vision in many patients.
Related conditions
Talk it through with Dr. Diafas.
For an assessment of central visual distortion, to discuss surgical treatment, or to seek a second opinion, book an appointment. Although a macular hole is not usually an emergency, early assessment and appropriate treatment are important.
This page provides general information only and is not a substitute for an individual consultation.