Macular holes are tears on the macula, which cause a defect or dark spot in the central vision, resulting in distortion and a loss of central vision.
The macular is the part of the retina used for visual task work such as driving and reading. A macular hole can develop and cause distortion and a loss of central vision making day to day activities/tasks problematic.
Macular holes tend to develop with age, usually appearing in people in their 60's and 70's and the occurrence is more prevalent in females.
Surgery is required to treat a macular hole and special follow-up care is required. Auckland Eye have enormous experience in dealing with macular hole surgery and will be on hand to support you through the whole process.
Auckland Eye is an affiliated provider to Southern Cross Health Society for OCT measurements.
In order to see clearly, light from an object has to be focused by the optical elements of the eye onto the retina. The retina is a thin layer, about the thickness of a piece of tissue paper, which is next to the inside wall of the eye.
There are certain parts of the retina that perform different visual tasks. For example the retina towards the front of the eye is best used for detecting objects in the dark. The macula is another small part of the eye which we use for visual tasks such as reading, driving and watching TV. A hole in this part of the retina is called a macular hole.
It is not yet known how holes develop in the macula. Some experts believe that the thin membrane lying on the surface of the retina can develop abnormal connections with the macula and a small tear may occur. If this tear enlarges, a full macular hole can develop.
Macular holes are more common in people in their sixties and seventies, although they can occur in other age groups. Women are more susceptible to developing macular holes than men. People with macular holes in one eye also have a greater risk of developing a hole in their other eye.
Some reports have suggested there is a higher incidence of macular holes in women who have had a hysterectomy and who are on hormone replacement therapy. However there are no reports suggesting discontinuing hormone replacement decreases the risks of a hole development, and most authorities do not advise stopping therapy.
During the mid 1990s micro-surgical techniques were developed which have proved successful in some patients with macular holes.
Macular hole surgery involves removal of the vitreous, a procedure known as a vitrectomy . The vitreous is a thick, transparent substance that fills the centre of the eye. This enables the surgeon to access and remove the membranes holding the macular hole open. Once the traction is released the hole can be closed.
The success of the surgery is dependent on the hole remaining 'sealed'. A gas bubble is placed in the eye to help repair and assist in keeping the macular hole closed.
Click here to view a short surgical video of a vitrectomy.
Click here to view a short surgical video of a vitrectomy with an epi-retinal membrane peel.
Click here to see a surgical video of a macular hole operation.
Macular hole surgery can be performed under local or general anaesthesia. The eye may a feel a little gritty and uncomfortable for a period following surgery but pain is rare. After surgery the patient must lie face down for a period of 10 days. Your surgeon will discuss the necessary posture requirements and success rates in further detail.
Auckland Eye - New Zealand Centre of Excellence for Eye Care