Macular hole symptoms

People with a macular hole will notice a difference in their central vision. It usually happens in one eye, and your side (peripheral) vision won’t be affected.

Common symptoms can include things like:

  • Blurriness or distortion
  • Straight lines looking kinked, or bent
  • Difficulty reading, watching TV or with close-up work
  • A dark or blank spot in your central vision

These symptoms will vary depending on the size and depth of your macular hole. You won’t experience any pain and you won’t lose your vision totally, but it’s important to see your optometrist when you notice these symptoms as treatment is often very successful.

What causes a macular hole?

It’s not always clear what causes a macular hole, although it can be linked with other conditions like:

Another cause is linked to changes to the gel-like fluid that fills the eye, called the vitreous, that is attached to the retina by lots of tiny fibres. As we get older, the vitreous begins to shrink and starts to pull away from the retina – this is completely normal and usually doesn’t cause any problems.

It is thought that as the vitreous jelly comes away from the back of the eye (a process known as posterior vitreous detachment), areas more firmly attached to the retina may tug the macula enough to form a small hole.

How does an OCT scan detect a macular hole?

The OCT scanner creates 3D cross-sectional pictures of the eye, which allows the optometrist to see the eye in even more detail, including the different layers of the retina.

Some people may not realise that they have macular disease until the condition is advanced, and their central vision becomes distorted or blurry. Regular visits to the optician are therefore essential to detect the early signs of macular conditions – and an OCT scan is a quick and painless test that is an efficient way to detect these conditions.

Learn more on our OCT page or book an appointment with an optician who will be able to explain the process in more detail. 

Surgery for macular hole

If the macular hole is in the early stages, ophthalmologists will often choose to monitor you for any changes over time.

If treatment is needed, it will usually involve surgery which aims to repair the hole and improve your vision. However, in the vast majority of cases, your vision will not get back to normal.

Vitrectomy

This is the main part of the surgery to repair a macular hole.

The operation involves removing the vitreous gel inside the eye and replacing it with a gas bubble to help the macula to heal. Taking the vitreous out stops it from pulling on the retina anymore, and the bubble lightly presses on the hole to encourage it to heal – a bit like a bandage.

The gas bubble will make your vision quite blurry, but over a few weeks the bubble will get smaller and eventually go away altogether. During this time, the eye will naturally produce some more fluid to replace it.

Recovering after macular hole surgery

You’ll be given some eye drops to use for a few weeks, and it’s best to avoid rubbing your eye, wearing eye make-up, going swimming or doing strenuous exercise while you’re recovering.

While the gas bubble is in your eye, your vision will be quite poor – so you won’t be able to drive for a few weeks and you’ll need to be careful with your day-to-day activities.

It’s very important that you don’t fly or go to high altitudes until the bubble has disappeared, as the pressure causes the bubble to expand, which can permanently affect your vision. If you have any other kind of procedure while you have the gas bubble, let your doctor know, as the gas can react with other substances.

Your ophthalmologist may also want you to position yourself in a particular way throughout the day to allow the bubble to stay in contact with the back of the eye as much as possible. This is called ‘posturing’ and involves either lying on your front or sitting at an angle. It can be quite bothersome, but your specialist will give you some advice on how best to do this.

As with any kind of surgery, there are risks of complications, and your specialist will go through all of this with you. One of the most common complications after macular hole surgery is the development of cataracts (a cloudiness in the eye’s natural lens). This usually happens the year after your macular hole surgery and can be treated with another operation.

Finally, if at any time after the operation you’re worried about additional symptoms, or if the eye becomes painful, get in touch with your ophthalmologist or go to your nearest eye casualty department.

We’re here to help

If you’ve noticed a change in your vision, or have experienced any of the symptoms mentioned above, it’s worth booking an appointment with one of our optometrists. For further information on OCT scans, head to our OCT resource here. You can also find out more about eye condition symptoms and treatments by visiting our eye conditions hub.

FAQs

Can a macular hole be cured?

With treatment, 90% of macular hole cases can be successfully repaired by surgery within 6 months. Treatment aims to close the hole which will help with distortion and may get some clarity back, but it is unlikely to restore vision fully.

How long does it take to recover from macular hole surgery?

It typically takes between six to eight weeks to fully recover from macular hole surgery.

How serious is a macular hole?

A macular hole can only affect the very central part of your vision (this affects the detail of things you’re looking at) rather than your peripheral vision, which will remain unchanged. How much detail is lost will depend on the stage and size of the hole.

Did you know?

Selected Specsavers stores provide a range of additional eye care services to help maintain the health of your eyes. Because these services are delivered on behalf of the NHS, there is no cost to you. Where NHS services are not available, there is a provate service. Ask your local store for details.