Macular hole

What is a macular hole?

A macular hole is a small break or tear in the retina, specifically in the macula. The retina is the light-sensitive layer of cells that lines the back of the eye, and the macula is the centre of it - it's the part that’s most densely packed with photoreceptor cells. 

We use the macula for seeing in colour and fine detail. 

What causes a macular hole?

The middle of the eye is filled with a clear jelly called vitreous humour. As we age, the jelly starts to pull away from the retina and sometimes it will take some of the macula with it, leaving a macular hole.

We don’t know exactly why macular holes develop, but some things make it more likely. Older age, being female and being very short-sighted all affect the chances.

What are the signs and symptoms of a macular hole?

Symptoms of a macular hole include central vision becoming blurred or distorted. It may become difficult to read or see well enough to drive. Objects may seem to be smaller than they should be. Eventually a dark spot may develop at the centre of your field of view.

A macular hole usually only affects one eye at a time.

Is a macular hole serious?

A macular hole can significantly affect central vision, making daily activities like reading or driving challenging. While it usually only affects one eye, it can lead to permanent vision loss if not treated properly, although it doesn't usually lead to total loss of sight.

How is a macular hole diagnosed?

A macular hole is diagnosed through a comprehensive eye examination that includes a visual acuity test and an examination of the retina. Optical coherence tomography (OCT) is a key diagnostic tool that provides detailed images of the retina, allowing the ophthalmologist to see the hole and determine its size and stage.

What are the treatments for a macular hole?

Options for treating a macular hole depend on whether the hole is still in the early stages, how big it is, and how it happened. Sometimes an eye injection with the drug ocriplasmin can help stop the vitreous jelly from pulling at the retina. 

If an injection doesn’t work or if the hole is at a later stage, then a type of keyhole surgery called vitrectomy can help close the hole in the macula. This involves removing the vitreous gel and injecting a gas bubble into its place. The gas expands and presses the macula back down so that it can heal in place. The surgery sometimes involves peeling away a very thin membrane that sits on top of the retina.

Once the gas bubble has disappeared, if the macular hole has closed your vision can continue to slowly improve over time but is unlikely to ever be as good as before the hole.

What research is there into macular holes?

Macular hole research is focused on developing the best ways to close the hole with the least damage to the light-sensitive photoreceptor cells. We've funded research into finding out who will benefit from macular hole surgery, and who won't be helped by it.

See our research projects