A macular hole is a relatively uncommon cause for loss of central vision. The first symptoms of macular hole may be slight distortion of vision, which soon progresses to a blind spot in the central vision. The symptoms of macular hole resemble those of macular degeneration initially. Macular degeneration is a totally different problem but occurs in the same place as macular hole.
Macular holes are treated by an outpatient surgical procedure called vitrectomy, membrane peeling and gas fluid exchange. The vitreous gel is removed, the internal limiting membrane is often removed from the surface of the macula, and the eye is then filled with a special gas bubble. Postoperatively, the patient must be positioned so that the face is down. In this position, the force of the bubble seals the hole. This position must be maintained for several days, although that may vary depending on the individual. There are several companies that provide equipment to support patients in maintaining the face-down position.
After surgery, the bubble will fill the eye, causing blurred vision when looking straight ahead. However, if the patient looks down and brings an object within a few inches of the eye, the patient will be able to see it clearly. Over time, the bubble dissolves. It may appear as a line in the vision and then gradually get smaller until one day it totally disappears. The time to dissolve depends on the type of gas used. While the bubble is present, the patient is restricted from flying in an airplane and from going to high elevations because this may cause the bubble to expand in the eye, resulting in severe glaucoma and loss of vision.
The surgery for macular hole has a success rate of over 90%. The visual outcome depends a lot on how soon the surgery is done and how well the patient complies with face down positioning. The better the vision is before the surgery, the better the chance for a good outcome.