Eye Conditions

Macular hole

The eye undergoes many changes as we age. Such age-related changes to the vitreous gel can begin to pull on the thin tissue of the macula until it tears, resulting in a small hole. This causes a small blind spot in the central vision. The good news is that, in most cases, a macular hole can be successfully treated

During the aging process a part of the eye called the vitreous changes from a gel to a more liquid structure that eventually collapses, causing a separation between the posterior surface of the gel and the retina. If the vitreous fails to separate cleanly at the macula, residual pulling on the retina can cause a macula hole to develop. This will subsequently affect vision.

Macular holes most commonly occur in those aged 60 years and over. Less common causes of macular holes include injury and long-term swelling of the macula. No specific medical conditions are known to cause macular holes.

Surgery is required to close a macular hole and improve vision. Around 95% of macular holes will be closed following surgery but the success rate reduces with larger or chronic holes. Almost all patients can expect improved vision after surgery but it is less common for vision to return completely to normal.



The symptoms of a macular hole include blurred and distorted vision or a small blind spot in the central vision.



The surgery required to treat a macular hole is vitrectomy. This surgery has a very high success rate in closing the hole and improving vision.


If left untreated, a macular hole will cause a blind spot in the central vision that becomes permanent.


What are the symptoms of a macular hole?

In the early stages of macular hole formation your vision becomes blurred and distorted. If the hole progresses, a blind spot develops in the central vision. Side vision remains normal, and there is no pain. It is uncommon for a macular hole to occur in both eyes.

What treatment will I need if I have a macular hole?

A macular hole cannot be treated by medication or laser. Instead it will require a surgery known as vitrectomy. Vitrectomy involves the removal of the transparent vitreous that fills the centre of the eye. The membranes that hold the macular hole open are removed, and the pulling that caused the macular hole is released allowing the hole to close.

Will my vision return after macular hole surgery (vitrectomy)?

The macula hole must close for vision to improve so it is good news that holes close 95 times out of 100 with surgery. If the hole closes, 7 out of 10 patients will have a significant improvement in vision. Distortion is a common symptom of macular hole and, although this invariably improves after surgery, it is likely that some distortion will persist even after successful closure of the macular hole. The best improvements in vision tend to occur in people with smaller holes that have been present for only a short period of time.

Why will I have to lay face down after surgery?

The aim of face down posturing is to keep the gas bubble in contact with the macular hole as much as possible to encourage it to close. Whether you are required to posture, and for how long, will depend on the size of the macular hole and the preferences of your eye surgeon. While there is evidence that posturing improves the surgery success for larger holes it may not be needed for smaller holes.

If you are asked to perform face down posturing, your head should be positioned so that the tip of your nose points straight down to the ground. This could be done sitting at a table or lying flat on your stomach on a bed or sofa. You should try to remain in this position for around 50 minutes in each hour for the duration advised by your eye surgeon. A short break of 10 minutes can be taken every hour to allow eating, trips to the bathroom etc.

If face down posturing is not prescribed, you will generally be advised to avoid lying flat on your back for around one week after surgery.

Can I get a macular hole in my other eye?

On average 1 out of 10 people with a macular hole will develop the same problem in their other eye. A careful examination by your eye surgeon will be able to tell you if you have risk of developing a hole in your other eye.