Macular Hole

Macula is the central part of the retina.  The centre of the macula (fovea) is responsible for the maximum clarity of vision as it is the point where the rays converge on the retina when the eye focuses on an image.  Macular holes happen when the vitreous jelly that normally fills the inside of the eyeball pinches away this very central part of the retina when it separates from the rest of the retina as a part of a degenerative process.

 

Who gets a macular hole

Macular hole tends to occur in the elderly. There are no known risks for this condition in a majority. Again for reasons unknown, it happens in women twice as often as in men.  Injury can sometime cause a macular hole.  If there is a macular hole in one eye, the risk of it happening in the other eye is higher.

 

Central visual loss, difficulty with reading vision and distortion are symptoms that can be expected.

Treatment options

Till recently surgery was the only treatment option for this disease.  The jel that fills the eyeball would have to be removed (vitrectomy) followed by peeling of a membrane on the retinal surface called the internal limiting membrane.  A gas is then injected to aid closure of the hole and would require face-down posturing for 2 weeks following the operation.

A drug called Ocriplasmin (Jetrea) has been licenced for treatment of this condition and has recently been approved by NICE.  Although the success rate of hole closure is much lesser than surgical treatment, it is a much less invasive procedure and has fewer risks.

External resources

Royal National Institute of Blind people (RNIB)

RNIB is a leading UK charity founded in 1824 and their website is the largest source of information available on the internet on blindness and partial sightedness. They also run a useful helpline.
http://www.rnib.org.uk/eyehealth/eyeconditions/eyecondi…

NHS Choices

A comprehensive website offering a detailed overview on this condition.
http://www.nhs.uk/conditions/macularhole…