A macular hole refers to a minute opening that emerges at the focal point of the retina within an area termed the macula. This pivotal part of the eye, known as the retina, serves as the light-sensitive surface. Nestled within it lies the macula, responsible for acute and central vision essential for activities like reading.
Initially, a macular hole may result in unclear and distorted vision. Visual cues such as straight lines might appear contorted or bent, and difficulties in perceiving small print may arise. Over time, a small void or an area of absence in the center of vision may become noticeable. This condition doesn’t induce any discomfort, nor does it lead to complete loss of eyesight.
Surgical intervention typically becomes necessary to mend the hole. While the procedure often proves successful, potential complications should be considered. Though vision may not fully revert to its previous state, surgical intervention generally leads to improvement.
Why Does It Happen?
The precise cause behind the development of macular holes remains elusive. In the majority of instances, no explicit cause is evident. These occurrences predominantly impact individuals between the ages of 60 and 80, with a higher prevalence among women than men.
One potential contributing factor is a condition termed vitreomacular traction. With advancing age, the gel-like substance known as the vitreous within the eye gradually separates from the retina and macula situated at the rear of the eye. Should remnants of the vitreous remain attached, it can lead to the formation of a macular hole.
Some isolated cases might be linked to:
- Retinal detachment: This occurs when the retina starts detaching from the blood vessels supplying it with essential oxygen and nutrients.
- Severe eye injury
- Mild long-sightedness (hyperopia)
- Severe short-sightedness (myopia)
- Persistent inflammation causing swelling of the central retina (cystoid macular edema)
What Should I do?
In case you experience blurred or distorted vision or detect a central black spot in your vision, it’s crucial to seek prompt medical attention from your GP or optician. Typically, you’ll likely receive a referral to an eye condition specialist, often an ophthalmologist.
Failure to seek assistance for a potential macular hole may lead to a gradual deterioration of your central vision.
Seeking treatment relatively early, within a span of months, could potentially result in better outcomes, notably in terms of vision improvement.
There are instances where the hole might naturally close and heal without intervention. Consequently, your ophthalmologist might opt for monitoring before suggesting any specific treatment.
What is the Treatment?
Vitrectomy surgery
The primary treatment for mending a macular hole involves a surgical procedure known as a vitrectomy.
Typically, this surgery demonstrates success in closing the hole for approximately 9 out of 10 individuals who have had the condition for less than six months. However, if the hole has persisted for a year or longer, the success rate tends to diminish.
Even if the surgical procedure doesn’t effectively close the hole, it commonly results in stabilizing your vision, potentially reducing vision distortion.
In a minority of cases, despite undergoing surgery, the hole might remain open, leading to continued deterioration of central vision. Nonetheless, a secondary operation could prove successful in closing the hole.
Ocriplasmin injection
An alternative treatment for macular holes stemming from vitreomacular traction involves an injection of ocriplasmin, commonly known as Jetrea, directly into the eye. This injection aids in the separation of the vitreous jelly from the back of the eye, facilitating the closure of the macular hole.
Administered in a matter of seconds, the injection is accompanied by local anesthesia, either through eye drops or an injection, ensuring a painless procedure. Eye drops to dilate the pupil are also provided to enable the ophthalmologist to examine the back of the eye.
Usually recommended in the initial stages when the macular hole measures less than 400 micrometers in width and causes severe symptoms, ocriplasmin injections might induce mild, temporary side effects, such as:
- Temporary discomfort, redness, dryness, or itching
- Eye or eyelid swelling
- Light sensitivity
- Occasional flashes of light
- Blurred or distorted vision
- Decreased vision or blind spots
In rare instances, more severe side effects may occur, including noticeable vision loss, enlargement of the macular hole, or retinal detachment. Surgical intervention typically becomes necessary to address macular hole enlargement or retinal detachment.
Immediate medical attention should be sought if experiencing:
- Severe decrease or distortion of vision
- Intense eye pain
- Double vision, headaches, or feelings of nausea
- Following the injection, there might be temporary blurriness in vision. It’s advisable to refrain from driving or using machinery until vision returns to normal.
Should the ocriplasmin injection fail to close the macular hole, the recommendation of vitrectomy surgery may be considered to achieve closure and enhance vision.