Macular hole is a condition where the central-most area of the retina responsible for focusing and detailed vision breaks down leaving a central "hole" and causing a central blind spot due to an absence of retinal tissue.

When the layers of the vitreous gel liquify and separate away from the central part of the retina (called the macula), the center gets pulled apart in different directions and a hole forms, called a macular hole.

At first the symptoms may be difficulty focusing or reading or noticing distortion. As the hole gets bigger a central blind spot, or an area where there is no vision and looks grey or black, becomes noticeable.

For full thickness (hole or defect is through the whole layer of the retina) macular hole (FTMH) the only effective treatment is surgery. Early detection and surgical treatment lead to favorable outcomes. In cases where the macular hole is very large, indicating it has been there for a long time, surgery may not be helpful in closing the hole or the vision recovery may be poor. Therefore, early detection is very important.

There is a different type of macular hole, called partial or lamellar macular hole, LMH, (partial layer of the retina in contrast to full layer or full thickness macular hole). In these cases, monitoring is usually the best option, as vision can remain fairly good. Surgery may not be indicated. Your retina specialist can determine the type of macular hole and discuss the best treatment course.

Vitrectomy and gas tamponade: surgery to repair macular hole