Patients with idiopathic macular holes present with a variety of symptoms.
- Initial symptoms include blurred central vision or metamorphopsia.
- Rarely, some patients may describe the exact moment at which the hole developed, but more commonly, they describe the onset as slow and gradual if at all noticeable.
- Later, a larger macular hole may produce a central defect, or scotoma, in the central vision.
- Some patients may be asymptomatic, and the hole is diagnosed only on routine ophthalmologic examination.
The visual acuity of the patient varies according to the size, location, and the stage of the macular hole. Patients with small, eccentric holes may retain excellent visual acuity in the range of 20/25 to 20/40. In addition, a macular hole that is not full thickness can have very good visual acuity in the range of 20/30 to 20/50. However, once a macular hole is well developed or full thickness, the usual range of visual acuity is from 20/80 to 20/400, averaging at 20/200.
A full-thickness macular hole can be visualized with direct ophthalmoscopy and reitnal imaging. It is characterized by a well-defined round or oval lesion in the macula with yellow-white deposits at the base.
- Trauma: Of patients experiencing a contusion injury of the eye, 6% develop a macular hole following the trauma
- Progressive high myopia (foveal schisis)
- Preceding rhegmatogenous retinal detachment
- Vitreoretinal traction theory (idiopathic macular holes)
The potential for better vision, as well as the 12% chance that the fellow eye will develop another macular hole, has prompted ophthalmologists to seek for a viable treatment of this condition.
Traditionally, macular holes are treated with vitreo-retinal surgery. Surgical management is recommended with documentation of a stage 2 or higher full-thickness macular hole. In surgery, three small ports are placed into the eye. A vitrectomy, or removal of the vitreous, is performed. Once this is completed, a dye is used to stain a small membrane called the ILM. It is carefully removed. A gas bubble is then placed in the vitreous space. After the surgery, the patient must perform face down positioning for up to one week. There is equipment available to assist you with this difficult task!
A newer treatment that is available for certain types macular holes is an injection of medication (ocriplasmin) into the eye performed in the office. We are the first practice in the NC Triangle Region to offer this medication and ground-breaking treatment.