Macular Hole

macular hole imageA macular hole occurs when a break forms within the macula due to traction from the vitreous gel.

The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is a normal occurrence and in most cases, there are no adverse effects.

However, if the vitreous is firmly attached to the retina when it attempts to pull away, it can tear the retina. When this occurs in the center of the macular area, a hole is formed. The fluid that has replaced the shrunken vitreous can then seep through the hole under the retina, causing blurred and distorted central vision.

Macular holes can also occur from eye disorders, such as nearsightedness, macular pucker. Eye diseases, such diabetic retinopathy and Best’s disease may also cause macular holes, as well as trauma to the eye.

Signs and Symptoms

  • Blurred central vision
  • Distorted, “wavy” vision
  • Decreased detail vision
  • Gray area in central vision
  • Central blind spot

Detection and Diagnosis

Visual acuity testing, Amsler grid, and ophthalmoscopy are all performed to evaluate the macula. Fluorescein angiography and Optical Coherence Tomography are also performed to assess the macular hole.


Vitrectomy surgery is recommended for the repair of a macular hole. During this procedure, a gas bubble is injected into the eye. With strict face down positioning, the bubble floats up against the retina pressing the hole closed to allow it to seal. Achieving good vision after macular hole surgery depends on many factors including the patient’s ability to position properly after surgery. Other things that may affect the visual outcome of this surgery are the length of time the macular hole has been there, the condition of the retina and its circulatory system.