The macula is the portion of the retina responsible for the clear, detailed vision. A macular hole is a condition that affects this portion of the retina.
A macular hole may occur for different reasons, eye injuries, inflammation inside the eye and aging. As we age, the vitreous gel in the back of the eyes shrinks and pulls away from the macula resulting in a Vitreous Detachment
with accompanying floaters. Sometimes, when the vitreous pulls it can form a macular hole.
Symptoms of Macular Holes
The severity of the symptoms of Macular Holes depends on whether the hole is a partial thickness or full thickness, but in general, may include the following:
- Blurred Central Vision
- Distorted, Wavy Vision
- Difficulty reading or seeing fine detail even with glasses
- Grayish Area in Central Vision
- Central Blind Spot or Dark Spot
Diagnosis and Treatment of Macular Holes
Macular Holes are easily identified through visual acuity testing, a dilated eye examination of the macula, and Optical Coherence Tomography (OCT).
Some macular holes seal by themselves and do not require treatment. In many cases, however, a surgery called vitrectomy is necessary to close the hole and restore useful vision. During the vitrectomy, the retinal surgeon will remove the vitreous gel in order to eliminate traction on the macula. A gas bubble is injected into the eye to help the hole to seal. As the hole closes, the eye slowly regains a part of the lost sight. The outcome for vision may depend on the size of the hole and how long it was present before surgery. The amount of visual recovery can vary.
For various reasons (eg. high nearsightedness) there may be areas where the retina is weaker. If the vitreous pulls in that area a retinal tear may occur. Tears most often occur in the periphery of the retina. Symptoms may include a sudden onset of flashes of lights and floaters or stationary blurred area in your peripheral vision.
Occasionally, a small tear may occur without obvious vision changes and are discovered during a retinal check at a routine visit with your optometrist or general ophthalmologist, in which they would refer you to a retinal specialist like Dr. Trotta for treatment. In the office, the laser is for treatment of a simple tear with or without a retinal hemorrhage. An untreated tear may progress to a more involved vitreous hemorrhage or a detachment and further vision loss in which other procedures would recommend.
Posterior Vitreous Detachment(PVD)
The center cavity of the eyes is filled with a thick gel-like substance called vitreous. As we age the vitreous becomes more liquid-like, therefore it moves and shifts around unlike the gel. This may cause floaters (floating spots and strings) in the vision which may be a nuisance and may diminish with time. Flashes of light may also be noticed.
The liquefying and movement of the vitreous can cause it to detach from the retina (PVD), and lead to other more serious retinal problems such as retinal tears, detachments, and macular holes. For this reason, new flashes and floaters should not be ignored. The doctor will closely observe vitreous detachments for a time to determine an early sign of the more serious complications.
François D. Trotta and the team at Idaho Retina are delighted to serve people in the Boise, Meridian, Nampa and the Caldwell areas. Call us today to schedule
your Macular Holes screening.