A macular hole is a small round defect occurring in the central retina, an area known as the macula. The macula is that portion of the retina responsible for central vision and is the principal area of the retina used for seeing fine detail during reading, watching television, and recognizing faces. A macular hole causes a bothersome blind spot or blurred area to be present directly in the center of an affected person’s vision. Visual acuity in affected individuals is usually between 20/100 and 20/200 (or 5 to 10 times worse than normal). Macular holes usually measure only ½ millimeter in diameter!

Macular holes affect women twice as frequently as men, and usually occur between the ages of 60 and 80. While macular holes typically affect only one eye, approximately 15-20% of individuals with a hole in one eye will later develop the same problem in their fellow eye.

The precise cause of macular holes is unknown although mounting evidence suggests that traction from the vitreous gel (the clear gel that fills the center of the eyeball) may cause the macula to be pulled apart leaving a small round defect in the most central portion (its weakest point). Individuals in whom the vitreous gel has peeled away from the central retina (i.e. a posterior vitreous detachment) have a much lower risk for the formation of a macular hole.

Prior to 1991, no effective treatment was available for macular holes. Since that time, vitrectomy surgery has been found to successfully close between 69-95% of macular holes with some patients recovering 20/20 vision! (the average person improves to about 20/50). Unfortunately, surgery for macular holes does have some drawbacks. First, most retinal surgeons agree that the use of an intraocular gas bubble with strict face down positioning postoperatively dramatically improves the success rate. While nearly everyone is capable of maintaining the necessary position, it isn’t easy. Also, cataracts develop within a few years in the majority of older individuals who undergo macular hole surgery which usually necessitates a second surgery one to two years later. Nevertheless, visual acuity without any surgery is usually around 20/200 which leads most patients with macular holes to opt for surgical intervention.

Dr. Goldman has extensive experience in the diagnosis and treatment of macular holes. If you or a someone you know has a macular hole or other retinal problem, please call us to arrange a comprehensive evaluation at either of our convenient locations.

Click here to see a photograph of a macular hole.