To get a better understanding of spot holes and their consequences, check out this slide hole spotting chart.Thanks!
A macular hole is a tear in the macula, the pigmented area of the retina that is central to vision and visual acuity, or clarity of vision. Your doctor may also refer to this condition as a macular cyst or retinal hole, tear or perforation. Macular holes tend to occur most often in older women, mostly women over the age of 60.
What causes a macular hole?
A number of things can cause a hole scar, including sharp trauma. The most common cause is aging. The vitreous humor – vitreous, for short – is the gel that fills the space between the retina and the lens of the eye. It tends to shrink as it gets bigger, in much the same way that gelatin shrinks from the side of a griddle or bowl if we leave it to sit for too long.
Most of the time there is no harm to this decrease, but sometimes the vitreous humor can stick firmly in one place of the retina. As the vitreous shrinks, it also pulls on the retina, eventually creating a small tear in the macula.
What are the symptoms of a macular hole?
Symptoms of floaters (small, dark lines or spots) include flashes of light, blurred vision, seeing straight lines and objects as curved or wavy, and blind or darkened in the middle space of the eye. Peripheral vision is not altered. The vision in the pure eye is not altered.
A dark spot makes it difficult to read, drive, or do other tasks that require the individual to see clearly.
Retinal diseases such as macular holes are usually painful, and the symptoms may seem quite mild at first. However, it is important not to ignore it, because some of these conditions left untreated can cause permanent damage, even blindness.
Are macular holes the same as macular degeneration?
But these two conditions are separate. Both are more common in older people. There are those and the like. Sometimes people who have macular degeneration also have a macular hole. Your eye care specialist will be able to tell the difference between them and should be consulted for any concerns or changes in vision.
Can it be treated topically?
Macular holes were once considered unforgiving. Today it is common to use microsurgery to remove the vitreous humor. This surgery is called a vitrectomy and is performed by a retina specialist. It is usually done the day of surgery, often under local anesthesia.
Vitrectomy involves the removal of the vitreous, paying particular attention to the part that is attached to the retina and the cornea. A gas bubble is injected into the space behind the retina. This gas will be absorbed into the body over a period of weeks, and the liquid will fill the space of the leaves. The gas holds the retina together while it heals, just as a suture holds the edges of a wound together or a broken bone holds it in place while it closes.
Vision improves over time, but may remain impaired for several weeks or months after the procedure. Vitrectomy is successful in about 70 to 90 percent of cases, but the amount of improvement will vary from patient to patient. Most people will see an improvement equivalent to about two or three lines on the vision chart. Surgery is most effective if it occurs within six months of the opening.
Risks of surgery include infection, retinal detachment, and rapid cataract growth. Patients should avoid air travel for several months after surgery, as changes in air pressure inside the eye can also affect healing.
Surgery is the only known treatment for a hole scar. Medications and lifestyle changes are not thought to reduce the roughness of the scar even if it does. Some people close up spontaneously, but you can’t just predict what they want, just as there is no way to predict who will open the spot hole.
Did I really lie on my face for several weeks?
The gas bubble tends to rise, so moving around means that the pressure on the retina during healing is not enough to restore vision. Many doctors recommend what is called a “face-up position” for anywhere from 7-10 days, up to three weeks after surgery. There are several medical aids that enable patients to perform activities of daily living while maintaining a face-down orientation. It is not necessary to sleep all the time!
Some doctors don’t feel it’s a necessary position on the face, or they’ll offer an alternative in which oil is injected into the eye instead of gas. This second surgery requires the oil to heal once the retina has healed, but it is an important option for those who are unable to maintain a facial structure.
What about the other eye?
There is a slightly increased risk of developing a macular hole in the second eye, but there is no way to prevent or predict its occurrence.
It is important that everyone has regular exams with a qualified professional. Individuals who are at risk for retinal diseases should seeing their eye get prompt care if they notice any worsening of their vision. or some information is listed.
Disclaimer:
This article is provided for informational purposes only and is not intended to replace examination and advice by a qualified health care provider.
Sources:
“Facts about the hole spot” National Eye Institute (NIH)
Canadian Ophthalmological Society and flashing
“Macular hole” Angeles Vision Clinic
“macular hole” Columbia Ophthalmology Consultants (Columbia University Medical Center)
Symptoms of retinal diseases” Mayo Clinic
“Modern Treatment for Macular Holes” St. Luke’s Eye Clinic
Report:
- Eye tests www.mdsupport.org/eyetests.html
www.nei.nih.gov/health/talktodoc.asp
www.associatedcontent.com/ slideshow/44997/vision_and_the_macular_hole.html?cat=70
