The macula is the part of the retina responsible for the acute central vision, the vision you use for reading, watching television, and recognizing faces. 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.
Most macular holes occur in the elderly. When the vitreous (the gel-like substance inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing a tear that can eventually form a small hole. Sometimes injury or long-term swelling can cause a macular hole. No specific medical problem is known to cause macular holes.
Macular holes that are just starting to form may be simply observed. Fifty percent of these holes resolve spontaneously. Holes that are more than minimal usually should have surgery in order to prevent really severe vision loss. More advanced macular holes and holes that have been present for a long time may or may not benefit from surgery.
Vitrectomy surgery, the only treatment for a macular hole, removes the vitreous gel and scar tissue that pulls on the macula and keeps the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient 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 and how long the hole has existed.
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.