A macular hole is a small break in the macula, the part of the retina responsible for sharp, central vision. This condition can cause blurred or distorted vision and, if left untreated, may lead to significant sight loss in the affected eye.
Though it may sound alarming, timely diagnosis and advanced surgical treatments can often restore much of the lost vision.
Read more to find why this eye condition happens, who it affects the most, and how it can be treated.
What is a Macular Hole?
To better understand this condition, it is essential to learn about the anatomy of the eye.
Our eyes contain a gel-like substance, known as the vitreous, which supports and shapes the eye and transmits light to the retina. At the centre of the retina lies the macula, which is responsible for forming sharp vision
Over time, the vitreous may shrink and tug on the macula. This traction can cause damage to the macula and leave a gap. This defect may be minor, but it can impair central vision.
Scroll to the next section to learn about its symptoms.
Macular Hole Symptoms
If you have an issue with the macula, your central vision will be hazy, and it can be frustrating to navigate and focus on things.
More symptoms are listed below:
- The vision or straight lines may appear distorted or wavy.
- There is a blurry spot in the centre of wherever you try to look.
- It may become difficult to read or observe fine details, which can affect your work.
- Objects may appear smaller and farther away, a condition known as micropsia.
You may notice that only your central vision is affected, while the peripheral vision remains clear. This happens because the macula is only responsible for sharp, central vision.
Common Macular Hole Causes
The onset of macular degeneration and the resulting hole can be triggered by injury, ageing, or underlying health conditions. The primary causes are listed below:
- With age, the vitreous gel may shrink and pull away from the retina, potentially tugging at the macula and creating a hole.
- Severe myopia (nearsightedness) can lead to thinner retinas and an increased risk of holes in the macula.
- Forest injury or trauma to the eye, like a blow or accident.
- Severe diabetes can weaken the macula, increasing the risk of holes.
- Macular Oedema, or swelling of the macula, can weaken macular tissue.
Some of the lesser-known causes include:
- Macular Telangiectasia (a rare retinal disorder)
- Inflammatory Diseases (such as uveitis)
- Previous surgery for cataract or retinal surgery
Women are more prone to hole in the macula than men, as per a report on PubMed Central. This higher susceptibility is linked to the changes in the estrogen levels during menopause in women; however, the mechanism behind it is still not fully understood, as the studies on the subject are still in the early stages, as per NCBI.
Different Types of Macular Hole
Ophthalmologists distinguish between different types of holes in the macula based on how severe the damage is and how much it affects the retinal layers behind the macula.
The four types are:
1. Full-Thickness Macular Hole (FTMH)
In this type, the tear goes through all the retinal layers. It causes significant damage to the central vision. This case requires surgical intervention to restore vision. Full thickness macular hole causes are mostly age, gender, and pre-existing retinal issues.
2. Lamellar Macular Hole
It is due to a partial-thickness defect in the macula, which may or may not involve some tissue damage in the retina. However, there is no full tear in the retinal layers. This causes mild visual distortion, but it does not always necessitate surgery.
3. Myopic Macular Hole
Individuals with severe myopia may experience increased structural eye elongation to achieve better focus, which can lead to retinal thinning and potentially develop a hole in the macula.
4. Traumatic Macular Hole
This happens due to injury to the eye. A minor hole in the macula may heal on its own, resulting in restored vision.
Stages of Development
The different macular hole stages reflect the extent of the damage. These are categorised into the four stages (source, NIH), as follows:
- Stage 1: The vitreous gel-like substance tugs at the fovea, causing it to lift but not yet fully break.
- Stage 2: A small full-thickness hole forms, which is still less than 400 μm in size.
- Stage 3: The hole enlarges ( ≥400 μm in size) without complete separation of the vitreous.
- Stage 4: A larger full-thickness defect occurs with complete vitreous detachment.
Early stages sometimes stabilise, but most progress without treatment. The stage plays a crucial role in deciding the best management plan.
Macular Hole Treatment and Surgery
If the hole is small, your doctor may advise you to wait and let it heal and close on its own.
In other cases, the eye specialist would perform a vitrectomy, a macular hole surgery in which the vitreous gel of the eye is removed. Any extra tissues that may be stressing the macula are also removed.
Sterile gas or silicone gel is injected into the eye to support the eyeball and vision. You may be asked to stay in a face-down position for 1 to 7 days to allow the bubble to remain in place until the natural eye fluids take their place.
After surgery, you may need to use protective eye drops and follow lifestyle precautions to ensure proper healing. The macular hole surgery recovery may take months to restore your vision to normal, so having realistic expectations about the treatment is advised.
Read More: Eye Conjunctivitis – How it Spreads, Symptoms and Treatments
To Sum Up
A hole in the macula is caused by damage to the macula, situated in the centre of the retina. It affects only the central vision, leading to blurry, hazy, or unclear vision, or a dark spot. The good news is that with modern surgery, it can be treated, and the vision can be restored. If you notice blurring, distortion, or a sudden dark spot at the centre of your sight, seek an eye specialist promptly. As in the initial stages, it can be healed with care and just eye drops.
Frequently Asked Questions Related to Macular Hole
How serious is a macular hole?
It can cause significant central vision loss (blurred/distorted central sight that affects reading and face recognition) and should be evaluated by a retina specialist; it rarely causes total blindness but is considered a sight-threatening central retinal problem.
When is it too late to treat a macular hole?
Not absolutely “too late,” but treatment outcomes are best when performed early—visual recovery and anatomic closure fall off for holes present longer than about 6 months, though surgery may still be offered for chronic holes in select cases.
Is it worth having macular hole surgery?
For symptomatic full-thickness macular holes, vitrectomy with internal limiting membrane peel and gas tamponade usually yields high anatomical closure rates (often >80–90%) and meaningful visual improvement, so surgery is commonly recommended after discussion of risks and expected gains.
What is the average age for a macular hole?
Macular holes are most common in older adults—typically over age 55—with many population studies reporting mean ages around 60–67 years.
Can stress cause a macular hole?
There is no strong evidence that psychological stress alone causes macular holes; the usual causes are age-related vitreous traction, trauma, or other ocular conditions—some research notes mechanical “stress” patterns in the retina but a direct causal link to emotional stress is unproven.
Does a macular hole heal itself?
A small percentage of early or very small macular holes may close spontaneously (reported rates vary by study), but most do not, so close monitoring or surgical repair is usually recommended if the hole is symptomatic or persistent.
