MACULA

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.

HOW DO MACULAR HOLES DEVELOP?

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.

WHAT ARE THE RISK FACTORS TO DEVELOPING MACULAR HOLES?

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.

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.

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.

WHAT TREATMENTS ARE AVAILABLE?

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 (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.

HOW LONG IS THE RECOVERY PERIOD?

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.