Macular Hole: Diagnosing and Treating This Tricky Eye Problem – Healthline


Blurred vision can be a real headache! Not only can it make your head throb if you’re struggling to see clearly, but it can also make daily tasks like reading, writing, and driving very difficult, if not impossible.
One potential cause of blurred vision is a macular hole in the eye.
While macular holes are not common, they do occur and there’s a lot to know about diagnosing and treating this eye condition and what to discuss with your doctor.
The retina is the delicate, multilayered nerve tissue that lines the inner eyeball. This part of the eye transmits light signals to the brain, where they’re perceived as visual images.
One critical territory within the retina is the macula, which in Latin means “spot.” It’s a very small zone, about the size of a pencil eraser. It allows us to see objects with crisp resolution.
A healthy macula is necessary for driving, reading, and other precise tasks. Abnormal changes to the macula result in an immediate loss of central vision. For example, people with diabetes-related eye disease can accumulate unwanted fluid in their macula, which is a treatable condition known as macular edema.
A macular hole occurs when layers of the macula separate or tear. A macular hole can be partial or complete.
The most common cause of macular holes is age. The vitreous naturally begins to pull away from the retina as someone ages. Normally this happens with no problems, but sometimes the vitreous can stick to the retina. This can cause the macula to stretch and a hole to form.
There’s not much research showing how prevalent a macular hole is. There’s an older population study, though, that found macular holes affected 7.8 people (and 8.69 eyes) per 100,000 people per year. The study focused on people in Olmsted County, Minnesota, who received a diagnosis of a macular hole between 1992 and 2002.
Macular holes can also sometimes occur when there’s an injury to the eye, or the macula swells from an eye disease.
Although age is a common cause, macular holes are different from age-related macular degeneration — even though the symptoms may be similar. Your eye doctor can help clarify which condition you have.
Early symptoms of a macular hole include blurry or wavy vision.
You may notice this when you’re reading or driving. It can start slowly, so this can be easy to overlook in the beginning. This is especially true if you have good eyesight in the other eye. Similar distortion occurs when looking with one eye at a time at a tiled wall, as found in bathroom showers.
As the hole progresses, it can cause a person to lose their central vision. However, a macular hole shouldn’t affect your peripheral vision. So, for example, you might be able to see someone’s face, but not their nose or eyes.
You’re more likely to develop a macular hole if you’re:
You’re also more likely to have a macular hole if you’ve had one in the other eye. About 1 in 10 people who get a macular hole in one eye will also get one in their other eye.
To diagnose a macular hole, an ophthalmologist will generally start by placing drops in the eye to dilate the pupil.
After the eye is dilated, the eye doctor will take pictures with an optical coherence tomography (OCT). This machine painlessly scans the back of the eye and can capture very detailed pictures of the retina and macula. The OCT is safe, as its imaging doesn’t rely on ionizing radiation.
The doctor can then study these pictures to make a diagnosis.
Treatment frequently requires close observation of small holes to ensure they don’t get worse.
Many macular holes spontaneously heal without intervention.
Surgery is required in most cases. This surgery is called vitrectomy and involves removing the vitreous pulling on the macula. After this is completed, a gas bubble is placed inside the eye to help flatten the macular hole and hold it in place during the healing process. Eventually, the gas bubble will go away on its own.
It may take several months for your eye to heal after surgery. The amount your vision improves may be impacted by the size of the hole and the length of time you had it.
After a macular hole surgery, you’ll have to restrain from certain activities, such as:
Aside from those restrictions, your eye doctor may also ask you to do the following:
Macular holes can impact your central vision and make daily tasks like reading and driving more difficult. They are most common in older adults and typically occur as the vitreous pulls away from the retina.
If you have blurred or wavy vision, it’s important to get your eyes checked by a professional.
Ophthalmologists can diagnose and offer treatments for any potential underlying conditions that may exist. Early diagnosis of conditions like macular holes is important as it can improve the chance of a return to full vision.
Last medically reviewed on July 27, 2022










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