The eye is full of a jelly-like material, called vitreous. As people age, the vitreous gel in the eye shrinks and pulls away from the retina. This is a natural part of aging and usually this occurs without consequence. However, in a small number of cases, the vitreous gel pulls strongly enough on the retina that it causes a hole. Unfortunately, this hole is usually located directly over the center of the vision (the macula), which results in blurring and distortion.
The macula is an oval area in the retina on the back of the eye where the photoreceptors are most dense and where the light is focused. The center of the macula is called the fovea. The macula is responsible for the central (or reading) vision. The macula has the greatest concentration of photoreceptor cells, and when the eye is directed at an object, the part of the image that is focused on the fovea is the image most accurately seen.
A macular hole can cause blurred or distorted vision. A hole that goes all the way through the macula can result in significant loss of central vision. There is no pain associated with a macular hole.
An ophthalmologists who suspects a macular hole may:
- Perform a visual acuity test to measure vision at a distance
- Perform a dilated pupil examination to see the inside of the eye with an ophthalmoscope
- Take pictures or use optical coherence tomography (OCT) to image the retina
- Perform a fluorescein angiography. During this test, a dye is injected into the arm and quickly travels throughout the blood system. Once the dye reaches the blood vessels under the retina, a photograph is taken of the eye. The dye allows the ophthalmologist to detect blood vessels that are leaking dye.
Macular holes can be successfully treated with surgery. This involves removing the vitreous gel and injection of gas inside the eye. The gas acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals. In order to maximize the effect of the repair, the patient is usually required to remain in a face down position for one week postoperatively to allow the bubble to press against the macula and seal the hole. Over the period of two to six weeks, the bubble will gradually be reabsorbed as the vitreous cavity refills with a naturally produced fluid.
Not every patient with a macular hole needs surgery. Patients should discuss the risks and benefits of treatment with their retinal specialist before proceeding with surgical repair.
Research is currently aimed at efforts to improve the 90+% success rate even more, and in a more convenient way to the patient. This is through ongoing surveillance of success in clinical series. Bascom Palmer Eye Institute conducts such series similarly to many other study centers in the country.
The Bascom Palmer Eye Institute advantage for patients with a macular hole
Bascom Palmer Eye Institute surgeons were among the first to perform macular hole surgery, dating back to 1991. Much of the framework of knowledge of pathogenesis, diagnostic methodology, and classification was laid at this institute. Because of this early experience, we continue to perform treatment on a high volume of patients. This allows us to make observations and conclusions regarding the most effective treatment modifications relatively rapidly.