macular hole

This is a small hole that forms in the macula that creates significant vision problems. The retina is located in the back of the eye and acts like film in a camera. The macula is the most important part of the retina as it is responsible for our fine central vision. If a hole forms in this area, the central vision “goes to pot.” There are several causes for a macular hole. One is an epiretinal membrane. This is a clear fibrous membrane that can form on the surface of the retina with age (and sometimes after trauma).  This membrane can contract like “shrink-wrap plastic” and cause traction on the retinal surface. This creates wrinkles on the surface of the retina and if bad enough, can pull open a full-thickness hole in the macula.  A hole can also form from the traction of a vitreous detachment.  The vitreous is the gel that fills the rear chamber of the eye. The vitreous has a tendency to contract and collapse inwards with age, tugging on the retina. This can create retinal tears or holes and lead to a retinal detachment. If this tugging occurs at the macula, a full thickness hole can result.  Macular holes, if small enough, may close on their own but often require surgical correction. This usually involves a membrane peel surgery.  In this surgery, a retina specialist will enter through the back of the eye and remove the source of the traction (i.e., remove the epiretinal membrane or vitreous jelly). Then, a gas bubble is injected into the eye in order to smooth out the retina, and (hopefully) the hole will close over the next several weeks. Though a commonly performed surgery, membrane peels are not always successful.  A macular hole causes central vision distortion that can be detected with an OCT scan of the retina. Amsler grid monitoring at home may pick up an early macular hole as well, but definitive diagnosis is made in the doctor’s office.