As we age (usually after the age of 45-50 years), the vitreous gel in the eye degenerates and liquifies resulting in floaters which move around in our field of vision. Most of the time, this phenomenon is harmless.  However, in some cases, the vitreous gel pulls too hard onto the macula or retina causing either a Macula Hole or Retina Hole / Tear.  The retina is the film layer at the back of your eye which allows us to see.

Image Credited to Dr YoanMB

Who gets a Macula Hole

• Older people (the risk increases with age)
• High myopia (short-sightedness)
• Trauma to the eye
• Retinal detachment
• Diabetic Tractional Retina Detachment

Click to watch EyeSmart AAO video on How Macula Hole occurs

Symptoms of Macula Hole

Although the symptoms are similar, Macula Holes are different from Age-Related Macula Degeneration (ARMD) because the visual loss can be worse (click to see)

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The symptoms are:

• Blurred Central Vision
• Distorted Vision around the Central area (called Metamorphopsia)

There are 3 stages of Macula Hole

Stage 1: Fovea Detachment

Stage 2: Partial Thickness Macula Hole

Stage 3: Full Thickness Macula Hole

Although the vision is relatively good at Stage 1, about half will progress to Stage 2 causing distortion of vision whereby lines look crooked and blurry.  If untreated, around 70% of partial thickness  macula hole will progress to Stage 3 causing loss of central vision making it difficult to read. 

Treatment of Macula Hole

Macula holes need to be treated with surgery called Vitrectomy (to remove the vitreous gel to remove the pulling forces on the macula & retina) followed by insertion of a special gas to press against the macula and close the hole.

Click to watch EVRS video on Treatment of Macula Hole

Post-Treatment Care

• You will need to apply eye medication to prevent infection and to reduce inflammation (click to see ).  Sometimes you may be given some medication to reduce the eye pressure
• You will need to posture (and sleep) FACE DOWN for most of the day.  After 1 hour of posturing face down, you are allowed get up for 10 minutes to go to the washroom.  You will need to do this for between 3-10 days.  Your eye doctor or nurse will advise you on the exact schedule.  The posturing is very important to ensure the macula hole gets to seal up properly
• You are NOT allowed to scuba dive or take a flight because the gas bubble will expand resulting in an increase eye pressure and severe eye pain

Check your vision regularly (at least once a week) using Amsler Grid and Vision Chart to monitor your condition

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If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.