A hole in the retina is a small opening that forms in the light-sensitive part of the eye.
Such holes can develop anywhere in the retina but may occur in the center, an area called the macula.
The macula is used for activities that require finer details like reading and recognizing faces, so people with a hole in this area may notice vision changes and find everyday tasks more difficult.
According to the Macular Society, macular holes affect around 3 in 1,000 people over the age of 55.
No one is certain what causes a hole in the retina. In fact, many cases don’t have an obvious cause.
But there are a few potential factors that may contribute to a macular hole.
With age, the vitreous — a gel-like substance that sits between the retina and back of the eye —can begin to pull away. If some of the vitreous sticks to the retina, the macula can split and a hole can form.
Other retinal holes may come about as a result of:
- severe eye injury
- ongoing retinal swelling
- diabetic eye disease
- retinal detachment
- being extremely near-sighted in at least one eye
- scar tissue forming over the macula and puckering
Not everyone with a hole in their retina has symptoms.
But if symptoms are present, they’ll start slowly and eventually be quite obvious.
You may experience:
- a dark spot in the center of your vision
- blurry, distorted, or cloudy vision
- an inability to see the smaller details of objects
One of the earliest things people notice is that reading small text is difficult and straight lines may look wavy.
But the extent of vision change can depend on where and how big the hole is. Some people find they’re unable to see a person’s nose or eyes when looking at them and others may find it difficult to drive or write.
It’s important to know that a hole in the retina isn’t painful and won’t lead to complete blindness in the affected eye.
Age is one of the biggest risk factors for macular holes, with people 60 and over more commonly affected.
More women than men appear to have the condition, too.
Other risk factors for retinal holes include:
- previously having a tear in the retina or retinal detachment
- diabetes
- inflammation in the eye
- history of eye injury or eye surgery
A quick test called optical coherence tomography (OCT) is the best way to diagnose a hole in the retina.
It doesn’t cause any pain but allows an eye doctor to see your retina and macula in great detail.
Usually, your eye doctor will give you eye drops to dilate your pupil. These drops will help them get a better look at the inside of your eye.
A sonogram-type device then scans the back of your eye using light waves and produces images for your doctor to assess.
Immediate treatment isn’t always necessary, and regular eye exams may be recommended instead.
But if your retinal hole is causing serious symptoms or is growing, a doctor or other healthcare professional may recommend surgery to repair it.
Vitrectomy
The most common procedure for macular holes is a vitrectomy. During this surgery, a doctor will remove any vitreous that’s on the surface of the macula along with a fine layer from the retina using small keyhole incisions and fine instruments.
They will then inject a gas bubble into the eye. This bubble holds the edges of the hole in your retina together, allowing the eye to naturally heal the hole.
The procedure takes around an hour, and you can be awake or asleep during it with an anesthetic.
As this healing process takes place, the gas bubble will dissolve. And although the bubble will affect your vision, it’s usually completely gone around 6 to 8 weeks after surgery.
According to the American Society of Retina Specialists, vitrectomy is more than 90% successful, with people gaining some or most of their lost sight back.
But your vision is unlikely to return to the way it was before the hole appeared. The success rate is also lower if you have had the hole for a year or longer.
As with any surgery, there are some risks, including:
- a cataract forming
- retinal detachment
- infection
- bleeding
- pressure in the eye
- re-opening of the macular hole
Sometimes, a second operation may be needed to fully close the hole.
Injection
Instead of surgery, a doctor may look into injecting ocriplasmin into the vitreous, which allows the gel-like substance to detach from the back of the eye.
This injection is painless — you’ll be given a local anesthetic and eye drops beforehand. But it’s often more suitable for people with a smaller macular hole and is able to successfully close 40% of such holes.
Less severe side effects of the ocriplasmin injection include:
- temporary irritation or redness
- swollen eye or eyelid
- sensitivity to light
- blurred vision
Rarer effects range from retinal detachment to a worsening of the macular hole.
Alternative treatments
There are
- laser photocoagulation, which burns the edges of the hole in order to create scar tissue that seals it
- cryopexy, which uses a probe over the top of your eye to freeze the tissue surrounding the hole and attach it to the inside of the eye
You’ll be given numbing treatment for either of these quick procedures and eye drops afterward to reduce swelling.
Some discomfort for a couple of days after is expected, and you may be told to reduce everyday activities until your eye heals.
If you have a vitrectomy, you’ll wake up with a protective shield taped over your eye. This is normally removed the day after surgery.
Your vision will be poor while the gas bubble dissolves. Imagine how it looks when you open your eyes underwater — your vision after vitrectomy may be like this temporarily.
This may mean you find it difficult to pick up objects and judge distances. You’ll also likely be unable to drive during the recovery period.
Finally, you won’t be able to do activities that involve high altitudes, such as flying or hiking up mountains. Scuba diving is also not allowed, as this may cause pressure to build inside your eye and affect the gas bubble.
As the bubble dissolves over 6 to 8 weeks, your vision will improve, and you’ll be able to return to your usual activities. Note that the full effects of surgery are often not seen for a few months.
A follow-up appointment is usually needed around 2 weeks after surgery. In the time between surgery and the follow-up, you’ll be given eye drops to take. The drops help stabilize the pressure in your eye and act as antibiotics.
If you received the injection, you’ll usually be monitored for up to a week afterward to check for infections or complications. But you can go home right after the procedure and may need to use eye drops.
If you experience severe pain or severely worsening vision after any procedure, head straight to an emergency department. Consult with a healthcare professional, too, if you notice other side effects that you’re worried about or that are persistent.
Without regular eye exams and treatment where needed, the hole will likely get worse. That means the central part of a person’s vision will decline over time.
But a hole in the retina won’t affect peripheral vision, so a person won’t become blind.
In some cases, a macular hole can heal itself, which is why it’s important to have it looked at regularly.
However, the quicker treatment is given, the better the outlook in most instances.
Remember, though, that surgery may not be able to give a person the vision they had before the hole, but it’s likely to improve it.
No, natural aging is one of the main risk factors for a hole in the retina.
But keeping your eyes as healthy as possible by having an eye exam every 1 to 2 years can allow for prompt diagnosis and treatment of any underlying conditions.
It’s natural to have a lot of questions when you have a health condition, particularly if it’s affecting a major sense like sight.
Whether it’s more about recovery from surgery or long-term outcomes, you’ll find answers to some of the other common questions about retinal holes below.
Is a hole in the retina the same as a retinal tear?
Some people use the words “retinal hole” and “retinal tear” to mean the same thing. After all, both are breaks in the retina and can produce similar symptoms.
But tears tend to occur when the vitreous tugs on the retina and holes are usually brought about by the retina thinning over time.
Retinal holes are also often smaller than tears and are less likely to lead to retinal detachment.
How long does it take to recover from treatment for a hole in the retina?
If you have surgery, the overall recovery process can take several months, though your vision will improve as soon as the gas bubble dissolves.
Nonsurgical procedures have a much shorter recovery period.
Do you have to sleep a certain way while you recover from treatment for a hole in the retina?
If you have a gas bubble injected into your eye, you may need to spend some time in a certain position that keeps your head still, so the bubble remains in contact with the hole.
This position is called posturing and involves lying or sitting face-down with your head on a table, bed, or sofa. Your healthcare professional will tell you how long you need to do this.
Posturing may not be needed if the hole in the retina was small. But you may still be told to avoid lying on your back for a couple of weeks after surgery.
Can you drive or fly after treatment for a hole in the retina?
In order to prevent the gas bubble from expanding, you may not be able to fly for up to 3 months after surgery.
If you travel to high altitudes during the recovery period, you may experience severe pain inside your eye and develop permanent vision loss.
Driving may also not be possible for up to 2 months after surgery and is usually only advised when the gas bubble has fully dissolved.
Is it possible to develop a hole in the retina again in the same or other eye?
It is possible to develop a retinal hole again in the future.
If you had a macular hole, there’s around a
Getting regular eye exams is the best way to monitor and treat any changes in your eyes. If a retinal hole is diagnosed, surgical and injectable treatments are available.
Treatment can help improve your central vision, but you may not have the same vision as before the hole developed. Still, the outlook is better when prompt treatment is given.
Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.