【Causes・Disease】

Macular hole is a condition in which a small hole (round hole) forms in the macula, located in the center of the eye’s retina, causing poor vision. The macula is a very important part of vision, especially the central vision for seeing small things. When a macular hole develops, central vision can be affected, and vision can be reduced.

Macular holes are often seen in middle-aged and older people over 50 years old, and rarely seen in young people. The incidence rate is about 0.09-0.3% in middle-aged and elderly people, it is reported that the incidence rate is 2-3 times higher in females than in male, and the incidence rate is higher in the elderly and patients with severe myopia. It usually develops in one eye and gradually worsens vision, but it can also develop in the other eye with a time lag (months to years).

The main causes are age-related idiopathies (no particular reason). One of the causes is the contraction of the vitreous gland due to aging and the detachment of the posterior vitreous gland. When the vitreous gland moves away from the retina, a force is exerted that pulls on the macula, forming a circular hole in the macula. There are also causes associated with severe myopia, trauma such as bruising, and cystic macular edema.

【Symptoms】

The main symptom of a macular hole is that the surrounding vision is normal, but the area you are trying to see cannot be seen or appears distorted, resulting in poor vision. Vision can be significantly reduced, especially if the circular hole is enlarged. Also, the center vision may look dark or black dots may be seen.
If left untreated, most people will have vision below 0.1.

【treatment】

No eye drops or oral medications are effective for macular holes.
The common treatment is vitreous surgery. Surgery removes the vitreous and replaces the water in the eye with gas.
After surgery, once the gas is filled, patients will be asked to remain face down for a period of time. In this posture, the injected gas presses the macular area, blocking the circular hole. In most cases, cataract surgery is performed at the same time.

【Summary】

Macular hole is a disease that can seriously affect vision, but in current ophthalmic treatment, surgery can often be expected to restore vision. After surgical treatment, many patients can recover their vision, but the degree of recovery varies depending on the size of the hole, the time from onset to treatment, and the patient’s age. If symptoms appear, it is important to see an ophthalmologist early and receive appropriate treatment.