14208 Macular Hole

Overview

A macular hole is a small break or gap in the macula, the part of the eye that gives you sharp, clear, central vision. It can make reading, driving, and seeing faces difficult.

Macular holes are not very common, but they are one of the reasons older adults may lose central vision.

Mostly people over 60, but it can happen at any age, especially after an eye injury.

Symptoms

Common symptoms

• Blurry or wavy central vision
• A dark spot or empty patch in the center of your vision
• Difficulty reading small print or seeing fine details
• Straight lines may look bent or distorted

Symptoms in children

• Children rarely get macular holes, but if they do, they may not complain about vision clearly. Look for trouble reading, squinting, or covering one eye.

Symptoms in older adults

• Older adults may notice a gradual dark spot in the center of their vision, wavy lines, or difficulty recognizing faces.

Causes

Main causes

• Age-related changes: the jelly-like fluid inside the eye (vitreous) shrinks and pulls away from the retina, sometimes creating a small tear or hole in the macula.
• Eye injury, in some cases.
• Very high or pathological myopia (severe nearsightedness).

Risk factors

• Being over 60
• Being female
• A history of eye trauma
• Having had certain eye conditions or surgeries

When to see a doctor

See a doctor urgently if:

• If you suddenly lose vision in one eye, call your local emergency number or go to the nearest emergency department.
• If you notice a sudden dark spot or a curtain-like shadow, see an eye doctor the same day.

Book a routine appointment if:

• If you are over 60 and have blurry or wavy central vision, make an appointment with an eye doctor.
• If you have had an eye injury and notice any change in vision, get it checked promptly.

Diagnosis

An eye specialist will use a special microscope called a slit lamp and usually an optical coherence tomography (OCT) scan to take a picture of the layers of your retina.

Tests that may be done

• Visual acuity test to measure sharpness of vision
• Eye dilation exam to look at the back of your eye
• Optical coherence tomography (OCT) scan to see the macula in detail

What to expect at your appointment

The tests are painless. You may have blurry vision for a few hours afterward if your eyes are dilated.

Treatment

Small macular holes sometimes heal on their own. Larger or longer-lasting holes usually need surgery to reattach the edges of the macula.

Self-care at home

• Avoid rubbing your eyes
• Rest your eyes during reading
• Wear sunglasses in bright light

Medical treatments

There are no eye drops or medicines that can close a macular hole. The main treatment is a type of eye surgery called vitrectomy. During this operation, the surgeon removes the jelly-like fluid in the eye and uses a gas bubble to press the retina back into place. The bubble gradually disappears over time.

When is surgery considered?

Surgery is usually recommended if the hole is large, causes significant vision problems, or has been present for less than a year.

Living with this condition

After surgery, you'll need to keep your head in a certain position for a few days to allow the gas bubble to work. Your central vision may stay blurry until the bubble goes away.

Lifestyle tips

• Avoid flying in an airplane until the gas bubble has fully dissolved
• Avoid scuba diving or extreme altitude changes
• Use good lighting for reading

Diet and exercise

Eat a balanced diet with plenty of leafy green vegetables and fish. You may need to avoid heavy lifting for a few weeks after surgery.

Mental health and emotional wellbeing

Losing central vision can feel frustrating and upsetting. It is normal to feel anxious or sad. Talk to your doctor if you feel down for more than two weeks.

Prevention

Macular holes cannot always be prevented, especially those related to aging. Protecting your eyes from injury can reduce the risk.

Vaccines

There is no vaccine for a macular hole.

Screening programmes

Regular eye examinations can help detect early changes in the macula, but there is no routine national screening for macular holes.

Complications

If left untreated

• Central vision loss
• Difficulty reading, driving, or recognizing faces
• The hole may become larger over time

Long-term outlook

With surgery, most people gain some central vision. Many recover enough to read and go about daily life. Your eye doctor will explain what to expect for your specific situation.

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