Observation
Some very early or partial changes can be monitored with repeat OCT when spontaneous improvement remains possible.
Macular surgery
Macular hole
A macular hole affects the central retina and may cause distortion, a blurred central patch or difficulty with detail.
Understanding the concern
A clear diagnosis comes before a treatment plan
The macula is responsible for detailed central vision. A full-thickness macular hole is a small opening in this tissue, usually related to traction as the vitreous changes with age, although trauma and other factors can also contribute.
OCT imaging confirms the diagnosis and shows the size and shape of the hole. Observation may be appropriate in selected early situations, while established holes are commonly discussed in relation to vitrectomy surgery.
What patients notice
Common visual changes
These features can overlap with other eye conditions. Examination is needed to establish the cause.
- Blurred central vision in one eye
- Straight lines appearing bent or wavy
- A small missing or grey patch in the centre
- Difficulty reading fine print
- Reduced ability to recognise faces with the affected eye
Specialist assessment
What the consultation may involve
Assessment establishes whether there is a full-thickness hole, associated vitreous traction and any other macular condition affecting the likely benefit of treatment.
01
OCT scan
OCT provides a cross-sectional view of the macula and is central to confirming and measuring a macular hole.
02
Dilated retinal examination
The rest of the retina is examined for tears, detachment, epiretinal membrane and other disease.
03
Lens and fellow-eye review
Cataract status and the vitreomacular relationship in the other eye may influence counselling and planning.
Treatment planning
Observation and surgery
The recommendation depends on hole stage, size, symptom duration, visual impact and the condition of the eye.
Vitrectomy with membrane peeling
Surgery removes vitreous traction and typically involves careful peeling of a fine internal limiting membrane around the macula.
Gas bubble and positioning
A gas bubble may support closure while the eye heals. The type and duration of positioning are determined by the operative plan.
From first assessment to follow-up
- 01Confirm central visual symptoms and their duration
- 02Perform OCT and a dilated retinal examination
- 03Discuss observation versus surgery and realistic visual aims
- 04Plan vitrectomy, gas precautions and positioning if advised
- 05Monitor hole closure and visual recovery with follow-up imaging
Macular surgery
At a glance
- OCT confirmation and monitoring
- Small-gauge vitrectomy when appropriate
- Gas and positioning advice where required
Planning care for a macular hole
Prof. Amer Awan's vitreoretinal work includes macular-hole assessment and small-gauge surgery. OCT findings, symptoms and the health of the eye guide whether observation or vitrectomy is appropriate.
Related surgical video
Inverted ILM Flap in Traumatic Macular Hole
From Prof. Amer Awan's official YouTube channel. This professional video contains surgical footage.
Questions patients ask
About Macular hole
Is a macular hole the same as macular degeneration?
No. Both affect the macula, but a macular hole is an opening related to tissue traction, while age-related macular degeneration is a different disease process.
Will glasses close a macular hole?
Glasses can optimise focus but do not close a full-thickness hole. OCT examination is needed to determine the stage and options.
Will I need to position face down?
Positioning recommendations vary with hole size, surgical technique and surgeon preference. Follow the instructions given for your operation.
Continue reading
Related eye-care pathways
Macular puckerUnderstand a different cause of central distortion.Amsler chartA simple at-home tool for noticing central distortion.Retina surgeryExplore specialist vitreoretinal assessment and surgery.
General information sources: Prof. Amer Awan - current public profile.