A macular hole is a small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. While there are many theories as to why this occurs, the simplest explanation is that as we get older, the vitreous jelly which fills most of the eye becomes liquid, shrinks, and separates from the back of the eye.
When this occurs, if there is an unusual adhesion between the vitreous and the macula, the vitreous can pull on the retina, stretching the thin spot in the center until it opens up, forming a macular hole. Usually no tissue is actually missing. Retinal specialists are trying to determine why macular holes occur and what can be done to prevent them.
In general, people do not go “blind” from macular holes. Even if surgery is not performed, it is reassuring to know that your side vision is almost always maintained.
The occurrence of a macular hole in one eye does not mean that the other eye will develop one. In fact, the chance of developing a macular hole in your good eye is probably less than 5%. Monitoring your Amsler grid on a daily basis will ensure early recognition of any changes in your good eye.
Using microscopic instrumentation, we are able to surgically close more than 90 percent of these holes with good results, which can either eliminate the black spot in the field of vision or a reduce its size. Most patients note less distortion and a two- to three-line improvement in vision on the eye chart.