What is a macular hole?
The macula is the central part of the retina, responsible for the sharp, detailed vision you use to read and recognize faces. A macular hole is a small full-thickness opening that develops in this central area. It is most often caused by the natural aging of the vitreous — the clear gel that fills the eye — which can pull on the macula as it shrinks and separates from the retina. In most cases there is no specific trigger; macular holes develop spontaneously.
Symptoms
Macular holes typically affect one eye at a time. Symptoms include:
- A blurred or smudged spot in the center of your vision
- Distortion of straight lines (door frames, telephone poles appearing wavy or bent)
Symptoms typically come on gradually, but can sometimes feel sudden once a patient notices them.
How we diagnose it
A macular hole is diagnosed with a dilated examination and confirmed with optical coherence tomography (OCT) imaging.
Surgical repair
Macular holes are repaired with a small-gauge vitrectomy. The vitreous gel is removed, a thin membrane on the surface of the retina is peeled, and the eye is filled with a gas bubble that holds the edges of the hole closed while it heals. Most macular holes close successfully with surgery, with the highest rates in smaller and earlier-stage holes.
Recovery and positioning
After surgery, most patients are asked to keep their head facing down for several days so that the gas bubble rests against the macula and supports healing. We provide clear instructions on how to position. Vision is blurred while the gas bubble is in place and clears gradually as the bubble absorbs over a period of weeks. No air travel is permitted while the gas bubble is present — cabin pressure changes can cause the bubble to expand dangerously. Visual recovery continues for months after the hole closes, with most patients regaining usable central vision.