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Posted 12/29/2022 by Amelia Grant

What to Know About Macular Hole

What to Know About Macular Hole

A macular hole is an opening in the macula of your eye that can be alarming. The macula is a specialized region of the central retina that allows us to see fine detail. When reading or driving, we use our macula and central vision to see details. Macular holes are most common in adults over 60 and can cause fast loss of central vision.

Symptoms of Macular Hole 

Macular holes normally appear gradually. When reading, you may notice missing letters, distorted vision, or fuzzy central vision in one eye at first. Straight edges can look wavy or bent. You may detect a missing spot in your vision or have significant central vision loss in severe situations.

Causes of Macular Hole 

Vitreous is a gel-like material that fills the rear cavity of the eye. The vitreous clings to the retina in some spots thanks to microscopic fibers. Vitreous begins to liquefy and collapse on itself as we become older. The vitreous may move away from the retina once this happens. This condition is known as posterior vitreous detachment.

Most elderly folks are unaware of this process, but a few people do notice "floaters" that appear and disappear in their vision. Unfortunately, the gel can tear away from the macula as well, resulting in a macular hole. In some circumstances, the retina's small fibers may pull on the macula, resulting in a macular hole. Fluid might build up, causing distorted or blurred vision.

Stages of Macular Hole 

The size and progression of macular holes are the criteria used to classify them. A macular hole goes through four stages:

Stage 1 (macular cyst)

A yellow macular cyst may occur when a new macular hole develops. Up to half of the macular cysts disappear on their own, and the macula returns to normal.

Stage 2 (early macular hole)

The cyst takes on the shape of an oval, crescent, or horseshoe. As vision deteriorates, it becomes distorted or hazy. Around 70% of stage 2 holes advance to stage 3.

Stage 3 (full-thickness macular hole)

The size of a stage 3 hole defines it. People with stage 3 holes frequently experience severe vision difficulties. A ring of raised tissue surrounds stage 3 macular holes.

Stage 4

Stage 4 macular holes are comparable to stage 3 macular holes, however, the patient also has a posterior vitreous detachment.

Treatment for Macular Hole 

If a macular hole is not caused by trauma or occurs in conjunction with other eye illnesses, it can usually be treated successfully. Larger and older macular holes have a lower likelihood of being treated successfully.

An optometrist or ophthalmologist monitors very early macular holes. An Amsler grid may be used by your eye doctor to assess your central vision. Additionally, your eye doctor may dilate your pupils and take digital retinal images. Optical coherence tomography, a relatively new tool, can be used to closely monitor you for suspected advancement into stage 2 macular hole.

Treatment for a macular hole that is Stage 2 or greater requires surgery by a retinal specialist. The vitreous gel is removed and replaced with a specific gas in the majority of macular hole surgeries.

This gas binds the macula's borders together, allowing it to recover. Depending on the surgeon, you may be required to hold your head in a face-down posture for anything from a few hours to two weeks during this gas therapy. The importance of this stage is currently being researched, as it is quite challenging for the patient.

The Bottom Line 

If one eye develops a macular hole, the other eye has a 30 percent risk of acquiring one as well. If you have a macular hole in one eye and a posterior vitreous detachment in the other, your chances of getting another macular hole decrease. See your eye doctor straight away if you detect any changes in your central vision. The importance of early detection and treatment of macular degeneration is critical for a favorable outcome.

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