A macular hole is a disease of the retina. The retina is a layer of light-sensing cells lining the back of your eye. This condition damages a portion of the retina called the macula, which is located in the center of the retina and enables you to see fine details clearly. You rely on your macula whenever you read, drive, or do other activities that require you to focus on fine details. A macular hole is a small, round opening in the macula. The hole causes a blind spot or blurred area directly in the center of your vision.
When the vitreous (the gel-like substance that fills the inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing an opening in the tissue that can eventually form a small hole. In some cases, injury or long-term swelling can cause a macular hole.
Your eye doctor may recommend vitrectomy surgery to treat the macular hole. During this outpatient procedure, your eye doctor uses fine instruments to remove the vitreous gel and scar tissue that is pulling on the macula and creating the hole. The eye is then filled with a special gas bubble to push against the macula and close the hole. With time, the bubble will gradually dissolve and is replaced with your normal eye fluid. During this time, you must maintain a face-down position for one to two weeks to keep the gas bubble in contact with the macula. Success of the surgery often depends on how well the position is maintained. With treatment, most macular holes shrink, and some or most of the lost central vision can slowly return. The amount of visual improvement typically depends on the length of time the hole was present.
To assist you in keeping your face pointed downward, special equipment is available, including adjustable face-down chairs, tabletop face cradles, face-down pillows, and mirrors. Some insurance companies cover the cost of rental of this special equipment.
Be sure to discuss your options with your eye doctor. If surgery is recommended, you should be aware that as with any surgical procedure, rare complications can occur, including infection, bleeding, retinal detachment, recurrence of the macular hole, and earlier onset of cataract.