The retina is the neurosensory tissue that lines the back wall of the eye. Like the film in a camera, the retina is responsible for creating the images that one sees. The center of the retina is called the macula and is the only part capable of fine detailed vision, i.e. reading vision, recognising faces, etc. The remainder of the retina , the peripheral retina, is for side vision. The retina outside the center of the macula, which makes up more than 95% of the retina, is not capable of the fine detailed vision.
Idiopathic Macular Hole
This is a condition affecting older people between the age of 60-80 years of age. It is somehow three times more common in women than men and although it usually affects one eye it can also affect the second eye in 5-10% of patients.
Most patients complain of blurry and patchy vision. More commonly there may also be distortion of images and lines when looking straight ahead.
The diagnosis of macular hole is made after a complete ocular examination which includes dilated retinal examination. If the condition is suspected or confirmed a simple non invasive investigation called an OCT (Optical Coherence Tomography) is performed to study the nature of the macular hole.
Prognosis and Management
Early macular holes do not need treatment as there is a good chance it will resolve. However established holes will usually progressively get worse and cause loss of central and reading vision. The only treatment option is a surgery called vitrectomy and then using a medium to long acting gas to close the retinal hole. The success of the operation involves careful removal of membranes around the hole and maintaining face down posture for up to 2 weeks on a very strict basis to allow the gas to close the hole. The success rate of this operation is up to 90% with improvement of vision of more than 50 %.