As one ages, the vitreous gel becomes more liquid and begins to collapse on itself. This may then exert a pulling effect on the central retina (macula) which is responsible for your clear central vision. Trauma can also cause the development of a macular hole. You may notice difficulties in reading or driving, depending on whether you dominant or non-dominant eye is involved. You may also notice a blurred central area in your vision, or distortion of your vision. This may appear quite suddenly.
A consultation and OCT (optical coherence tomogram) can quickly and accurately diagnose the condition and a treatment plan can be devised. Surgery is usually advised. The earlier the duration of the hole and the smaller the hole, the better the prognosis. Surgery can be performed as a day case under local or general anaesthetic. If transport is a problem, we can book an overnight bed in the hospital. A posterior vitrectomy is performed , a surface membrane peeled off the macula, and an intra-ocular gas is injected at the end of surgery. This gas acts as a drying agent at the edges of the macular hole, and allows the edges to come back together passively. For the first 5-7 days post-operatively, your homework is to keep any fluid in the eye away from the hole by lying propped up or sitting. The old-fashioned posturing of face-down is no longer required. As we use minimally –invasive surgical techniques, suturing of the wounds is seldom required and the procedure is relatively painless. Whilst there is gas in the eye, vision will be very poor and you will likely find driving difficult until the gas is at least halfway reabsorbed .( gas lasts between 2-8 weeks depending on the case) While there is gas in the eye you cannot ascend to altitude beyond Pinetown or fly in an aeroplane as the gas bubble expands and causes pressure problems in the eye.
80-85% of macular holes close with one surgery but unfortunately vision will always be different to what it was before the macular hole formed. Most people do notice an improvement in the quality of the central vision and a decrease in the amount of distortion present.
Blurring of central vision and distortion of central vision is not specific to macular hole. It may also occur in epiretinal membrane, diabetic maculopathy and age-related macular degeneration. Consultation will confirm the correct diagnosis.
