The macula is a tissue located at the center of the retina. The retina is the tissue in the back of your eye that turns light into images, and the macula is the part of the retina that is responsible for your central vision. The outer edges of the retina are responsible for your peripheral vision. In some cases, your macula may tear, resulting in a macular hole. Here are four things you need to know about macular holes.
What causes macular holes?
The inside of your eye is filled with a gel-like substance called the vitreous humour. The vitreous humour helps your eye maintain its round shape and also holds your retina in place.
As you get older, your vitreous humor shrinks and may pull away from your retina. If the vitreous humor is too firmly attached to the retina, it will pull the retina with it as it moves away. This phenomenon is called vitreous traction, and it's considered to be an important cause of macular holes.
Trauma to your eye can also force your vitreous humor away from your retina and have the same effect. When you suffer a blunt force trauma to your eye, the globe of your eye is forced to compress and expand suddenly, and this force can pull your vitreous humour forwards.
What are the signs of macular holes?
The symptoms of macular holes are fairly vague at first. In the early stages, macular holes can make central vision slightly blurry. You may notice that you're less able to make out fine details when you're looking at far away objects, but you may think that you just need a new prescription for your glasses.
As the holes get bigger, the vision changes become more obvious. A blind spot will develop in the middle of your vision and your vision will be distorted. This vision distortion has been compared to looking through wavy glass and is impossible to ignore.
Generally, these symptoms only occur in one eye. It's possible for both eyes to be affected by macular holes at the same time, but this is not a common occurrence. If you notice changes in your vision—even seemingly-minor changes like difficulty seeing fine details—see your optometrist for an eye exam.
How serious are macular holes?
If macular holes aren't treated, the vitreous traction will continue to exert force against your retina, and this force will eventually pull your retina away from the back of your eye. This is known as retinal detachment, and it's a medical emergency. If you suffer a retinal detachment, you could become blind in the affected eye. Fortunately, macular holes can be treated.
How are macular holes treated?
Macular holes can be treated with intravitreal injections of ocriplasmin, a medication that targets fibronectin and laminin, two proteins that hold your retina to your vitreous humour. By targeting these proteins, the medication is able to resolve your vitreous traction and give your macula a chance to heal itself. Studies have shown that 40.6% of eyes treated with this medication experience non-surgical closure of macular holes; the rest will need to have surgery.
If you need surgery, you'll need to have a vitrectomy performed. During this surgery, your ophthalmologist will make an incision in your eye and carefully remove the vitreous humour with suction. Once the vitreous humour is gone, a bubble of gas will be injected into your eye. This bubble will hold your macula in the proper position while it heals, without subjecting it to any further traction. According to Medscape, this procedure closes macular holes in 91% of cases.
If you think you have a macular hole, see an optometrist immediately at a clinic like Montgomery Eye Center. Macular holes are very serious and can lead to blindness, but with prompt treatment, you have a good chance of recovery.