What is a Macular Hole?
The macula is a small spot at the center of the eye’s retina. It is the sharp light-sensitive area responsible for accurate focus and color production required for reading, driving, recognizing faces and seeing clearly. When tissues of the retina get torn or detached due to vitreous shrinkage, it creates a hole in the macula and is called ‘Macular hole.’ This condition causes distorted, blurred sight and a dark spot in the central vision. It commonly occurs in people over 55 years, especially in women.
Other names: Macular Degeneration or age-related macular degeneration (AMD or ARMD).
Mainly ‘aging’ is the primary cause, but there are some other factors which increase, namely:
- Fatal injury or trauma
- Vitreous fluid shrinkage (a gel-like substance called vitreous humor-filled inside eyes starts shrinking and gets more liquefied with aging)
- Myopia (high amount of nearsightedness)
- Detached retina
- Diabetic eye disease
- Macular pucker
- Inflammation in the eyes (uveitis)
- Inherited eye disease
- Environmental factors
- Sudden distortion
- Blurriness when looking straight
- Objects and straight lines begin appearing quite bent and wavy.
- Notice grey, black spots or blank areas in their vision
- Difficulties while reading and doing work requiring focus
Stages of Macular Hole
Macular hole affects only one eye, and rarely occurs in both the eyes at a time. It only harms the central vision, so the peripheral vision/side vision of a person remains entirely secured and unaffected. There are three stages which measure and define the condition as well as tell us the deterioration levels.
- Foveal detachments: Chances of 50% cases to worsen without treatment
- Partial-thickness holes: About 70% cases to worsen without treatment
- Full-thickness: Most cases worsen without treatment
OCT (Optical Coherence Tomography) is the most reliable approach to examine and diagnose the disorder. It is a fast non-invasive imaging technique which facilitates the cross-sectional and three-dimensional analysis in high resolution by using reflected light. Slit lamp examination and Amsler grid are the most basic physical examinations before going for OCT.
‘Pars plana vitrectomy’ is a surgical procedure most commonly used to treat macular hole. In this process, the vitreous gel inside the eye is removed to stop it from pulling on the retina and further a gas bubble is placed to mildly hold the fringes of the macular hole until it gets healed.
Surgery is done under local anesthesia and it is very important for the patient that after surgery he/she is in a “face-down” recovery position. In some cases, another potential treatment is ‘injection of ocriplasmin’ into the vitreous fluid.
The usual complications of post-operation are infections, cataract development and probably retinal detachment because these patients are at higher risk of repercussions.
Success stories of the vitrectomy and macular hole recovery are mostly positive. Better care with proper guidance leads to a favorable improvement in visual acuity of the patient. It is very important to have regular follow-up examinations by an eye doctor as it helps to identify and cure the disease at an early stage.