Treatment for Macular Holes in Baltimore

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The term “macular hole” applies to a particular form of damage that afflicts the macula, that portion of the retina that not only manages your central field of vision but also houses all the eye’s cones, the photosensitive cells that make color vision possible. While a macular hole tends to appear after age 50 and produces central vision symptoms similar to those of macular degeneration, it is a very different condition — one that can be surgically repaired by our team of eye doctors at Elman Retina Group in Baltimore.

Like the rest of the retina, the macula is attached to the inner lining of the eyeball. When the vitreous humor, the gelatinous inner “filling” of the eye, begins to shrink and liquify with age, it can tug at the macula. In most cases, this produces only superficial damage such as increased “floaters.” Sometimes however, a significant chunk of retinal tissue can actually be pulled away from the macula, leaving a macular hole. While age-related vitreous humor shrinkage is the primary cause of macular holes, you could also get one due to macular edema or other eye disease, trauma, severe myopia or underlying health conditions.

Signs That You Might Have a Macular Hole

A macular hole may or may not cause vision symptoms depending on its size. The condition is classified by stages. Stage 1, or foveal detachment, sometimes may resolve by itself without affecting vision, while Stages 2, 3 and 4, which involve partial-thickness or full-thickness holes, are likely to grow progressively worse without treatment. Symptoms of a macular hole include:

  • A sudden reduction of vision in one eye
  • Straight lines appearing wavy in the affected eye
  • Blurriness in your central visual field
  • A central blind spot

Treatment Options

Our ophthalmologists at Elman Retina Group may recommend different treatment approaches for different stages of a macular hole. For instance:

Small macular hole with no vision loss – If your macular hole is extremely minor and isn’t currently affecting your vision at all, we may recommend a “watchful waiting” stance, using regular eye exams and close monitoring to detect any changes in your condition. If you’re very lucky, the hole may never grow larger and will close on its own.

Small macular hole with some decrease in vision – If your vision is somewhat affected by a small macular hole, an injectable medication or gas bubble may be able to stabilize the hole so it can heal itself. The eye is numbed prior to the injection, so it is not painful. Although injections do not work on everyone, they can be effective in releasing the vitreous pulling on the macula. Common aftereffects during recovery from intravitreal injections can include blurry vision, increased sensitivity to light, floaters, flashes of light and eye pain.

Larger macular hole – Most macular holes that are beyond stage 1 require a form of surgery known as vitrectomy. Vitrectomy is an outpatient procedure in which the ophthalmologist removes the natural vitreous pulling on the retina and replaces it with a gas bubble. The bubble functions as a type of bandage, putting pressure on the macular hole long enough to heal.

During the vitrectomy recovery, you must maintain a face-down position for one to seven days, depending on the case. This position keeps the gas bubble in the proper position, where it can maintain proper pressure on the macular hole. Special equipment is available to help make the face-down position more comfortable and ease strain on your neck, back and shoulders. You are also discouraged from flying for up to two months after surgery, as changes in air pressure can cause the gas bubble to expand and lead to complications. Vitrectomy can cause mild eye pain, eye redness and a scratchy feeling in the eyes. Any symptoms can be controlled with eye medication.

Frequently Asked Questions About Macular Holes

Is a macular hole the same as macular degeneration?

A macular hole and macular degeneration cause similar symptoms as both are diseases in the macular region, but they are not the same condition. Treatment for macular hole differs from treatment for macular degeneration.

What causes a macular hole?

A macular hole occurs when the vitreous, or clear gel-like material filling the eyeball, shrinks and pulls away from the retina. If the vitreous is attached to the macula in some areas, this pulling can cause a small hole to form.

The shrinkage of the vitreous is most often due to age-related factors. The majority of patients affected by macular holes are in their 50s or older.

How effective is vitrectomy for treating a macular hole?

Vitrectomy is the most effective way to treat a macular hole causing vision loss. Depending on the case, the average successful hole closure rate is 90-95 percent after just one surgery. However, visual improvement after vitrectomy can vary by patient, with some patients recovering more vision after vitrectomy than others. Most patients who have vitrectomy for a macular hole find their vision is not as good as it was prior to the onset of symptoms.

What are the risks of vitrectomy?

The risks of vitrectomy include infection, bleeding in the eye and a detached retina during or after surgery. Vitrectomy can also speed up the rate of cataract development.

What happens if I do not have macular hole surgery?

If you have a macular hole but decline surgery, the hole might enlarge over time. Your vision can continually and permanently decline, too.

If you delay macular hole surgery long enough, you may not see noticeable visual improvement after the procedure. Repairing a macular hole early offers better chances for substantial improvement in visual acuity.

Why do I need to stay in a face-down position after vitrectomy?

Maintaining a face-down position after vitrectomy allows the gas bubble in your eye to put pressure on the macular hole so it can seal itself. If you do not keep a face-down position, the macular hole may not close properly.

Contact Elman Retina Group Today

Don’t let a macular hole put a hole in your quality of life. Contact the Elman Retina Group to receive the necessary macular hole treatment today!