Macular Hole

A macular hole forms when there is traction on the macula from the vitreous that pulls the center of the macula enough to form a hole in the center of the vision.

What is a Macular Hole?

The macula is the center of your retina. It is responsible for your straight ahead vision. While reading the print on this page, you are using your macula. The cornea and lens in the front of your eye focus the image of these words onto your macula. The macula converts the light from the image on this page into a neurological signal that is processed by your brain. Since the very center of the macular is the thinnest part of the retina, it is also relatively weak. Some patients have an abnormally tight attachment between the vitreous gel that fills the eye and the center of the macula. When the vitreous gel contracts with aging, or after an injury, these people can develop a macular hole. Interestingly, 90% of macular holes occur in females. The reason for the female predilection for macular holes is unknown.

Macular Hole Stages

Macular holes are staged from 0 to 4. A stage 0 macular hole is not visible. It only shows up as a vitreous attachment at the center of the macula with optical coherence tomography scanning. Most eyes with stage 0 macular holes never develop a symptomatic macular hole. A stage 1 macular hole is not a full thickness macular hole. It forms when the center of the macula is tented upward from traction but a hole has not formed. Less than half of eyes with stage 1 macular holes develop a full thickness macular hole. Most of these eyes heal on there own. Stage 2 macular holes are small full thickness macular holes. Twenty percent of these holes will heal on there own. Most do not. Stage 3 macular holes are larger macular holes where the vitreous is still attached to the hole. Stage 4 macular holes are larger macular holes where the vitreous is not attached to the hole.

Macular Hole Spontaneous Closure

Small macular holes (Stage II) have about a 20 percent chance of spontaneously closing. The animated image with this text shows a macular hole that closed without surgery. Since macular hole surgery is never an emergency, it is sometimes worthwhile waiting a short time to see if a small macular hole will close on its own. When macular holes abort, or spontaneously close, the vision often returns all the way to normal over the course of about a year. There is often a small piece of tissue that can sit in front of the fovea, a pre-foveal opercula, that can block the vision. In the accompanying image, the patient took over a year for the pre-foveal opercula to pull free of the macula.

Macular Hole Surgery

Surgery is successful in closing macular holes that are less than 6 months old nearly 100 percent of the time. About 90 percent of macula holes close with one surgery. Some require multiple surgeries. Once a macular hole is closed, the vision improves some in 80 percent of eyes, a lot in 50% of eyes (to 20/40 or better), and to nearly normal in 10% of eyes (20/20). Even eyes with normal vision usually have some distortion in the vision for at least a year from the surgery. The risk of surgery is mostly that of retinal detachment (2%-10%), infection (0.01%) and bleeding (0.1%). Cataracts from in most eyes undergoing vitrectomy for any reason in patients over 50. Without surgery macular hole patients usually only lose the very center of their vision. The side vision stays good. Many older patients (85 and up) with a second good eye may decide not to have surgery for macular hole. To repair a macular hole, the surgeon first removes all the vitreous from inside the eye. This relaxes the edges of the macular hole. Many surgeons also do an internal limiting membrane peel further relaxing the edge of the hole. Then the patients eye is filled with gas. The gas pushes the hole closed like a draw bridge. In order for the gas to push on the hole, the patient must look toward the center of the earth after the surgery. Many different surgeons recommend different regimens. Most require a few days to a week of 90% face down positioning. There are pillows and message tables available in most cities for rent if patients want the extra help.

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Most patients with macular hole choose to have surgery. Macular holes over 6 months old can be closed, but the visual acuity results are not as good as they are for fresh holes. Even old holes, five to 10 years old, can be closed with surgery. In these situations there is about a 50% chance of improving vision.

Dr. Pautler's Blog on Macular Hole

Video Macular Hole Surgery without ILM Peel

This patient had a two month history of vision loss from a macular hole. The pre-operative OCT scan showed a stage II macular hole with a diameter of about 250 microns. The scan did not show a taught internal limiting membrane. This surgery is done with a short acting sulfur hexafluoride gas and no internal limiting membrane peel. The patient positioned for a week after surgery (Strict for 3 days). The hole closed and the vision has improved to 20/30 at 2 months.



Video Macular Hole Surgery with ILM Peel

Macular hole surgery in a patient with a stage 2 macular hole. The internal limiting membrane is peeled. A short acting gas was used (sulfur hexafluoride) and vision was 20/50 1 week after surgery. This surgery was done 1 month ago. Vision at 1 month visit was 20/40.



Macular Hole NEWS

Below are current articles from a Google News Feed on Macular Hole

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TIME

A Laser Pointer Burned a Hole in a 9-Year-Old Boy's Eye, Doctors Say
TIME
Macular hole, in general, is usually repairable, but it doesn't usually happen from laser pointers,” explains Dr. John Miller, director of retinal imaging at Massachusetts Eye and Ear. (Miller was not involved in the case.) “The laser actually heats ...
Laser pointer burns hole in boy's retinaWSVN 7News | Miami News, Weather, Sports | Fort Lauderdale

all 3 news articles »

CBS News

Laser pointer burns hole in young boy's eye
CBS News
The doctors also found a "large macular hole" in the retina of his left eye. "The child reported playing with a green laser pointer and repeatedly gazing into the laser beam," they write. Because of the large size of the hole, the doctors decided on a ...
Macular Hole from a Laser Pointer | NEJMThe New England Journal of Medicine
Is Your Laser Pointer Dangerous Enough to Cause Eye Injury? - American Academy of OphthalmologyAmerican Academy of Ophthalmology

all 65 news articles »

fox8.com

Laser pointer burns hole in Greece boy's retina
fox8.com
Examination revealed a large hole in the macula, a small area in the retina that helps with discerning detail in faces and while reading or driving, the doctors said in a case report published Wednesday in the New England Journal of Medicine. Further ...

and more »

Metro US

Are laser pointers dangerous?
Metro US
"Macular hole, in general, is usually repairable, but it doesn't usually happen from laser pointers," Dr. John Miller, director of retinal imaging at Massachusetts Eye and Ear, told Time. "The laser actually heats up the tissue…and almost burns or ...

and more »

Globalnews.ca

Boy burns hole in his retina after aiming a laser pointer right at his eye
Globalnews.ca
Doctors discovered a “macular hole” in the boy's left eye – meaning there was a break in the central part of his retina, where the eye's light-sensitive tissue is located. According to the U.S. National Eye Institute, a macular hole can cause blurred ...


Times of Jersey (press release) (blog)

Global Ophthalmic Viscosurgical Devices Market to Surpass $ 606.83 Million by 2023
Times of Jersey (press release) (blog)
OVDs are also used in Vitreo-retinal surgical procedures such as macular hole repair and various other retinal surgeries. Government initiatives to increase awareness levels regarding regular eye check-up will increase demand for the products in the ...


This Is The Horrifying Reason You Should Never Stare Into a Laser Pointer
ScienceAlert
When the doctors examined the boy, they found a large hole in the macula - the central area of the retina, where light is focussed from the front of the eye. It's responsible for colour vision and visual acuity. Macular holes are not uncommon in the ...


RochesterFirst

Laser pointer burns hole in Greece boy's eye
RochesterFirst
"Lasers can damage the eyes in several ways, from burning the cornea to causing macular holes, which can lead to permanent vision loss," Khurana said. "Some of these effects are immediate and others can occur years after the initial insult. It is ...

and more »

Action News Now

CROSSTALK RED DRESS
Action News Now
result -- a large macular hole. there wasn't much doctors could do for the boy, and his vision remained poor. the f-d-a warns consumers many lasers sold on the internet could be extremely dangerous -- and should not be considered toys. cecile cecile ...


Health Highlights: June 22, 2018
U.S. News & World Report
They discovered a large hole is in the macular, an area in the retina that helps distinguish detail in faces and while reading or driving. There was also damage to two areas below the macular hole, CNN reported. Vision in the 9-year-old boy's injured ...

and more »

Retinal Drugs Market : Industry Demands, Top Key Players, Industry Analysis & Forecast By 2017 – 2025
mymarketgazette.com
Some of these diseases involve only the macula such as age-related macular degeneration, macular pucker (epiretinal membrane), or macular hole; other diseases can impact the entire retina such as retinal detachment or diabetic retinopathy. The ...

and more »

chemicalreport24.com

Retinal Drugs And Biologics Market Projected to Grow Steadily During 2017-2027
faircolumnist.com
The disorders related to retinal health include age-related macular degeneration, diabetic retinopathy, infectious retinitis, macular edema, macular hole, retinoblastoma, retinal degeneration, retinoschisis and uveitis etc. There are various types of ...
Retinal Drugs Market : Size, Application Analysis, Regional Outlook, 2017 – 2025mymarketgazette.com

all 10 news articles »

Inverted ILM flap technique closes large macular holes
Healio
An inverted internal limiting membrane flap technique for the treatment of large macular holes offered a higher incidence of type 1 closure with improved functional outcomes compared with the standard internal limiting membrane peel, according to a study.


Surgical outcomes differ depending on type of lamellar macular hole
Healio
Patients with lamellar macular holes with lamellar hole-associated epiretinal proliferation tend to have worse visual outcomes compared with patients who have highly reflective epiretinal membranes. A retrospective chart review of 33 patients divided ...


The Asian Age

Shocking: Boy left with untreatable hole in eye after playing with laser pointer
The Asian Age
A scan revealed a large hole in macula (left part of retina), which is crucial for mapping out faces and words. Normally macular holes are treatable, though the surgery inevitably causes cataracts, which permanently clouds vision. However, even that ...


Autologous retinal transplants are 'true transplants' for macular holes
Healio
NEW ORLEANS — Autologous retinal transplants for macular holes provide “true transplants” and are not just plugs, according to a speaker here. “With the autologous retinal transplant at this stage, we didn't have any major complications. I don't think ...


Foveal Avascular Zone Area Analysis in Macular Hole Before and After Surgery Using Optical Coherence Tomography ...
Healio
To analyze the foveal avascular zone (FAZ) area in superficial and deep retinal layers in patients with macular hole (MH) before and after surgery. PATIENTS AND METHODS: The authors studied 14 patients with unilateral MH. They examined a 3 mm × 3 mm ...


Vitrectomy yields more macular hole closures than Jetrea
Healio
BOSTON — Visual outcomes were similar in eyes with bilateral macular holes that underwent a vitrectomy or intravitreal ocriplasmin injection, but primary macular hole closure rates were higher in eyes that underwent a vitrectomy, according to a poster ...


Republican Journal

Nevertheless, they persisted
Republican Journal
“The Persistence of Vision: Early and Late Works by Artists with Macular Degeneration” runs through July 29 at the DAAP Galleries' Philip M. Meyers Jr. Memorial Gallery at the University of Cincinnati. It features more than 50 works and sets pre ...


Surgical Chairs Market : Growth, Trends and Demands Research Report and Forecast 2017 – 2025
The Newsman
Commercially, surgical chairs are available in manual and automatic positioning systems. Ophthalmic chairs are specifically designed to facilitate ophthalmic surgeries such as retinal detachment, glaucoma, macular hole, cataract, and refractive surgery.

and more »

MD Magazine

CNV Removal Improves Complications with Anti-VEGF Therapy for AMD
MD Magazine
Although, based on their findings, they suggested that “rapid resolution of macular edema and contraction of the CNV and/or mild increase in the vitreous traction after anti-VEGF therapy could potentially cause a macular hole. CNV removal via the ...


Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole
Healio
Exclusion criteria for the study eye were a concurrent ocular disease other than macular hole involving the posterior segment (eg, uveitis, retinal vein occlusion, glaucoma, optic neuropathy), any previous posterior segment surgical or laser treatment ...


Recent top ophthalmology news
Healio
Surgical outcomes differ depending on type of lamellar macular hole. Patients with lamellar macular holes with lamellar hole-associated epiretinal proliferation tend to have worse visual outcomes compared with patients who have highly reflective ...

and more »

Northwest Trail

Global Wavefront Aberrometer Market Study 2018- Alcon, Bausch & Lomb, Carl Zeiss Meditec AG, NIDEK, Topcon ...
Northwest Trail
Furthermore, the report encompasses the main product type and segments Reusable, Disposable as well as the sub-segments Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole, Others of the global Wavefront Aberrometer market ...


Few patients need management changes after pars plana vitrectomy
Healio
In a retrospective review of 375 patients after uncomplicated PPV for epiretinal membrane and macular hole with normal postoperative day 1 exam, 97.3% had uneventful postoperative week 1 visits without any need for management changes. Ten patients ...


Autologous retinal transplantation used to treat macular hole
Healio
Patients who have undergone multiple failed procedures to close macular holes may benefit from a new autologous retinal transplantation technique, according to its developer. Autologous retinal transplantation should be considered for patients who have ...


BLOG: Conditions that can be exacerbated by cataract surgery
Healio (blog)
Vitreomacular traction, on the other hand, is part of the spectrum of macular holes (either stage 1 or 2). The effect of cataract surgery on these eyes is somewhat unpredictable. In eyes with recently diagnosed significant traction, retinal clearance ...


The Villages Daily Sun

Athletes overcome challenges to compete
The Villages Daily Sun
Diagnosed 27 years ago with macular degeneration — the nation's leading cause of vision loss that affects more than 10 million Americans — Sohlman's eyesight has dipped from capable of reading a letter to legally blind. It also has affected his three ...


Bel Marra Health

Macular hole causes, symptoms, treatments, and difference from macular degeneration
Bel Marra Health
Macular hole is an eye condition that typically appears in people over the age of 60, but it is not the same as the much talked about eye disorder macular degeneration. It's important to understand what makes them different, especially if you have a ...


Vitrectomy in patients 85 years of age and older: surgical outcomes and visual prognosis
Dove Medical Press
Mean improvement in VA in eyes of patients with the comorbidity of age-related macular degeneration (n=34) was 41% lower compared to eyes of patients without the disease (n=48, p=0.013). In the subgroup of patients operated on for retinal detachment, ...

and more »
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