LaserVision

What is Macula Hole?

The posterior chamber of the eye is filled with a clear gel-like substance called vitreous. In the healthy, young eye, this gel is firmly attached to the retina and the macula. But as the eye ages, or secondary to eye disease, the vitreous liquefies, shrinks, and pulls away from the retina. Over time, it separates completely from the retina: a process called a posterior vitreous detachment (PVD) which is a normal part of ageing and usually happens by the age of 70yrs.

In some patients, the vitreous doesn’t detach completely and part of it remains stuck to the macula, at the centre of the retina. The vitreous pulls and tugs on the macula, causing vitreomacular traction (VMT). This tension can damage the macula resulting in a macula hole and can cause vision loss if left untreated. Macula hole has its own specific symptoms, however, they can also be a sign of another eye disease. Therefore it’s important to book an appointment with Laser Vision and see an ophthalmologist for an evaluation when you first notice any of the symptoms mentioned below.

Macula Hole Symptoms

What are the Symptoms?

  • Distorted vision that makes a grid of straight lines appear wavy, blurry, or blank.
  • Seeing flashes of light in your vision
  • Seeing objects as smaller than their actual size

What are the Causes?

VMT is usually caused by part of the vitreous remaining stuck to the macula during a posterior vitreous detachment. A macula hole may develop with prolonged traction on the retina. People with certain eye diseases may be at a higher risk for VMT and macula hole, including those with: high myopia (extreme short-sightedness), age-related macular degeneration (AMD – a breakdown of tissues in the back of the eye), diabetic eye disease (disease that affects the blood vessels in the back of the eye) and retinal vein occlusion (a blockage of veins in the retina).

Causes
Causes

What are the Causes?

VMT is usually caused by part of the vitreous remaining stuck to the macula during a posterior vitreous detachment. A macula hole may develop with prolonged traction on the retina. People with certain eye diseases may be at a higher risk for VMT and macula hole, including those with: high myopia (extreme short-sightedness), age-related macular degeneration (AMD – a breakdown of tissues in the back of the eye), diabetic eye disease (disease that affects the blood vessels in the back of the eye) and retinal vein occlusion (a blockage of veins in the retina).

Macula Hole Diagnosis

What is the Diagnosis?

Some cases of VMT / maula hole may spontaneously resolve. For patients whose symptoms are severe enough to require intervention, pars plana vitrectomy surgery is one treatment option. The procedure involves the manual release of vitreous attachment and alleviation of traction. This is combined with peeling of any epiretinal membrane.

Intravitreal injection of Ocriplasmin, which induces enzymatic release of the vitreous from the retina / macula, may be recommended instead of surgery. This technique has been approved by NICE for patients with VMT with no epiretinal membrane and a macular hole of ≤400μm horizontal width and / or severe visual symptoms. It has a lower success rate, in terms of hole closure, than surgery (around 34%) but can produce a significant improvement in vision.

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