Macular holes develop when the layers of the macula within the retina separate, which leads to progressive loss of central vision. In most cases, surgery is necessary to correct it.

Macular hole in the eyeShare on Pinterest
A macular hole in the back surface of the eye. Yoanmb, CC BY-SA 4.0, via Wikimedia Commons

Blurred vision can be a real headache! Not only can it make your head throb if you’re struggling to see clearly, but it can also make daily tasks like reading, writing, and driving very difficult, if not impossible.

One potential cause of blurred vision is a macular hole in the eye.

While macular holes are not common, they do occur and there’s a lot to know about diagnosing and treating this eye condition and what to discuss with your doctor.

The retina is the delicate, multilayered nerve tissue that lines the inner eyeball. This part of the eye transmits light signals to the brain, where they’re perceived as visual images.

One critical territory within the retina is the macula, which in Latin means “spot.” It’s a very small zone, about the size of a pencil eraser. It allows us to see objects with crisp resolution.

A healthy macula is necessary for driving, reading, and other precise tasks. Abnormal changes to the macula result in an immediate loss of central vision. For example, people with diabetes-related eye disease can accumulate unwanted fluid in their macula, which is a treatable condition known as macular edema.

A macular hole occurs when layers of the macula separate or tear. A macular hole can be partial or complete.

The most common cause of macular holes is age. The vitreous naturally begins to pull away from the retina as someone ages. Normally this happens with no problems, but sometimes the vitreous can stick to the retina. This can cause the macula to stretch and a hole to form.

Macular holes can also sometimes occur when there’s an injury to the eye, or the macula swells from an eye disease.

Although age is a common cause, macular holes are different from age-related macular degeneration — even though the symptoms may be similar. Your eye doctor can help clarify which condition you have.

  • Stage 1: Visible elevation in the fovea (center of the macula) without vitreous detachment.
  • Stage 2: Visible partial-thickness holes in the fovea without vitreous detachment
  • Stage 3: Visible full-thickness holes in the fovea without vitreous detachment
  • Stage 4: Visible full-thickness holes in the fovea with complete posterior vitreous detachment (PVD)

During stage 1, you may notice some vision loss, but not always. From that point, your central vision continues to deteriorate as the condition progresses.

Early symptoms of a macular hole include blurry or wavy vision.

You may notice this when you’re reading or driving. It can start slowly, so this can be easy to overlook in the beginning. This is especially true if you have good eyesight in the other eye. Similar distortion occurs when looking with one eye at a time at a tiled wall, as found in bathroom showers.

As the hole progresses, it can cause a person to lose their central vision. However, a macular hole shouldn’t affect your peripheral vision. So, for example, you might be able to see someone’s face, but not their nose or eyes.

You’re also more likely to have a macular hole if you’ve had one in the other eye. About 1 in 10 people who get a macular hole in one eye will also get one in their other eye.

Other risk factors include:

  • being over 60 years old
  • being a female assigned at birth (FAAB) over 65 years old
  • being very nearsighted (myopia)
  • previous eye surgery
  • previous acute blunt-force injury to the eye that causes contusion on the macula

To diagnose a macular hole, an ophthalmologist will generally start by placing drops in the eye to dilate the pupil. They then do a slit-lamp biomicroscopy to look at the fundus, which is the inner, back surface of the eye.

They may also take pictures with optical coherence tomography (OCT).

This machine painlessly scans the back of the eye and can capture very detailed pictures of the retina and macula. The OCT is safe, as its imaging doesn’t rely on ionizing radiation.

The doctor can then study what they observe in the examination and in imaging to make a diagnosis.

Treatment frequently requires close observation of small holes to ensure they don’t get worse.

Usually, you will need to have a vitrectomy, which is a surgical procedure that removes the vitreous pulling on the macula.

Afterward, the surgeon will place a gas bubble inside the eye to help flatten the hole and hold it in place as you heal. This gas bubble will dissolve on its own.

It may take several months for your eye to heal after surgery. The amount your vision improves may be impacted by the size of the hole and the length of time you had it.

After a macular hole surgery, you’ll have to restrain from certain activities, such as:

  • No flying or diving: Avoid traveling to high altitudes or scuba diving when there’s still any air in the eye postsurgery.
  • Limited dental work: Try to limit dental work, specifically, those involving nitrous oxide (or laughing gas) while there’s gas in the eye after surgery.
  • Bending or lifting: Avoid this activity for at least 1 week after surgery.
  • Soap and water: Try to not get soap or water in the eye when you wash your face or take a shower, for example.

Aside from those restrictions, your eye doctor may also ask you to do the following:

  • wear sunglasses during the day
  • wear an eye patch or shield after the surgery
  • use eye drops after the surgery

Can a macular hole fix itself?

Macular holes may heal on their own without intervention, but in many cases, you will need surgery to correct them.

How common is a retinal hole?

A 2017 study found the total incidence of retinal, or macular, holes to be 41.1 per 100,000 people, with a higher incidence in women than in men.

That said, other studies have determined different estimates, so more research is needed to understand how common macular holes actually are.

How serious is a retinal hole?

Macular holes can impact your central vision and make daily tasks like reading and driving more difficult. It’s important to seek treatment in order to stop the condition from progressing.

Macular holes are most common in older adults and typically occur as the vitreous pulls away from the retina.

If you have blurred or wavy vision, it’s important to get your eyes checked by a professional.

Ophthalmologists can diagnose and offer treatments for any potential underlying conditions that may exist. Early diagnosis of conditions like macular holes is important as it can improve the chance of a return to full vision.