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What is a Macular Hole and How Does it Affect Your Vision?

Eight of every 100,000 people will develop a macular hole in their lifetime. That means that almost 30,000 people in America will be affected. Over 70% of those 30,000 will be females and 98% will be over the age of 55.

Only 3% of the total number affected will be younger and only 30% will be male.

But, what is a macular hole? How does it happen? Are you at risk to develop one? How are they treated?

Read on for the answers to these questions and more as we dive into the details of a macular hole and how it affects vision.

What Is the Macula and Where Is It Located?

The eye is made up of eleven main structures. They are the sclera, choroid, retina, macula, vitreous body, optic nerve, ciliary body, iris, pupil, cornea, and anterior chamber.

The sclera, choroid, retina, and macula all work together to help the eye perform its primary function, sharp and clear sight.

The sclera is the outer coating that protects the entire eyeball. The choroid is directly under the sclera on the backside of the eye and supplies blood to the retina. The retina is the nutrient and blood-rich inner tissue of the back of the eye.

The macula is at the center of the retina and is responsible for maintaining sharpness and clarity of sight straight ahead of you. It’s a tiny part of the retinal wall that has a pretty big role in how you view the world on a daily basis.

It contains tons of photoreceptors that analyze the light signals and process the light into images. The rest of the retina is responsible for providing our peripheral vision.

What Is a Macular Hole and How Does It Happen?

The vitreous body of the eye is made up of a spongy gel substance and helps support the retina and other structures at the back of the eye. As you get older, this gel degrades and begins to shrink and pull away from the back of the eye.

Sometimes, if this degradation and pulling happen quicker than usual it can leave a hole in the small macular structure. When the vitreous gel seeps out of the hole and into the macula you’ll experience blurred and distorted vision.

As the vitreous gel continues to degrade it keeps tugging and pulling at the stuck portion of the macula. This keeps making the hole bigger and bigger. Sometimes in the first stages, the vitreous gel releases the hold on the macula and the hole seals up on its own.

While most people have heard of macular degeneration. This is a disease that slowly degrades the photoreceptors. It is completely different than a macular hole caused by the breaking away of the vitreous gel.

The Three Macular Hole Stages

There are three different stages in macular hole development. Each stage offers its own risk of progression. If you notice any deterioration of your vision, see a doctor right away. The sooner you get diagnosed and treated the better.

Stage one is known as foveal detachments and is the first indication of a small macular hole. Some of these small stage one holes take care of themselves without treatment. About half of all stage 1 macular holes will progress into a worsened state without treatment.

Stage two is called partial thickness. If the vitreous gel continues to pull on the edges of the hole it’s more likely to continue and require medical intervention. Once you’ve reached this stage there is a 70% likelihood of progression of the condition without treatment.

Stage three is full-thickness holes. At this stage, your central and detailed vision has become severely affected. It’s likely you’ll have little to no central vision left.

If left untreated, these holes can cause serious complications like a detached retina which will also cause problems with your peripheral vision and eventually lead to total blindness.

How Is a Macular Hole Is Diagnosed?

If you’re suffering from blurry vision it’s important to see a doctor right away. In order to determine the presence of a macular hole, the doctor will perform a test called Optical Coherence Tomography, or OCT for short.

This test provides the doctor with a picture of the backside of your eye where the retina and macula live. To perform the test, you’ll rest your chin on a machine and a camera will take several scans of the eye.

Nothing touches your eye and you won’t feel any discomfort. The multiple scans allow the doctor to make a diagnosis of a macular hole or other disorder causing your blurred vision.

Are You at Risk?

Most will never experience a macular hold but, if you’re older and have certain risk factors your chances can go up. If you already have one of these other eye conditions you may be at a heightened risk for developing a macular hole:

  • Severe short-sightedness
  • Retinal detachment
  • Diabetic retinopathy
  • Other eye injury or previous trauma

If you have any of these conditions make sure to let your doctor know. They’ll keep a closer eye on it and will test you more regularly for problems at the back of the eye.

What Are Your Treatment Options?

So, you’ve received a diagnosis of a macular hole. What now? What kind of treatment are you facing?

Some minor stage 1 holes can seal up on their own. However, most holes will require macular hole surgery to close them up and protect your central vision.

The surgery is called a vitrectomy. It involves the removal of the remaining vitreous gel to stop the tugging. The gel is replaced by a bubble of air and gas to provide pressure on the edges of the hole so healing can occur.

Recovery isn’t the most comfortable thing you’ll ever face. After the surgery, you can expect to spend two to three weeks face down in bed. This will allow the bubble to provide constant pressure on the hole. Macular hole recovery depends on the patient remaining in this position to allow the bubble bandage to aid in the hole healing itself.

Make sure you ask lots of questions about recovery and what it looks like before going under the knife. If you have trouble laying on your stomach or won’t have assistance during recovery you need to bring this to the doctor’s attention.

Surgery may still be viable since there are some options to make the recovery easier. Some choose to use massage chairs so you can place tasks on a small table below you. A ring pillow is essential to place on your bed while you sleep so you can breathe and be supported in the face-down position.

What Is the Threat to Your Vision?

The threat can be as serious as complete central blindness. You can also be facing a very serious condition called retinal detachment which threatens your peripheral vision as well. Ignoring these conditions will inevitably lead to total blindness in the affected eye.

At the end of the day, blurred or distorted vision is not normal. It’s important to have regular vision screenings. This allows the doctors to catch changes early and allow for treatments to protect your vision. Early detection allows for less invasive reversal methods and more likelihood of solving the problem through surgical means.

The main goal of any eye doctor is to protect the quality of your vision for your entire life. Make sure you make your eye health a priority by scheduling follow-ups with your team.

Early Diagnosis and Treatment Are Very Beneficial

A macular hole doesn’t have to mean the end of your vision. But, it is a condition that is highly likely to get worse if left untreated.

If you have any pre-existing conditions that heighten your risk for macular complications make sure you share that with your primary care physician and eye doctor. Catching things early means there is a better chance of saving your vision and letting you continue to see your world for years to come.

Are you located in East Tennessee and looking for a phenomenal team of doctors to care for your eyes? We have you covered.

Contact us today to book an appointment. Our in house team can perform all the tests you need to make a diagnosis. We also offer surgical procedures and can treat anything we find.

Drs. Campbell, Cunningham, Taylor & Haun, The Campbell Cunningham Laser Center and Eye Surgery Center of East Tennessee are located at Weisgarber Road in West Knoxville. We also have convenient locations in Farragut, Fountain City, Maryville, Sevierville, Oak Ridge, and Hardin Valley.