A diagram showing cross section of the eye with different parts labelled

A macular hole describes a small gap which develops in the macula at the centre of your retina.

A macular hole is a very different eye condition from macular degeneration, even though they both affect the macula. For this reason, they are treated differently to each other.

This page contains a summary of our information on macular hole. To read our full information, download our factsheet:

Download our macular hole factsheet in Word



Quick links
– What causes a macular hole?
– How does a macular hole affect vision?
– What treatment is available for macular hole?
– Can I do anything to avoid or improve a macular hole?
– Coping



What causes a macular hole?

Often there is no known reason why someone develops a macular hole. They are more common between the ages of 60 and 80 and women experience them more often than men. It has been linked to: 



How does a macular hole affect vision?

If you develop a macular hole you will probably notice changes in your central vision. These changes may range from only a slight worsening of central vision to a very noticeable decline, depending on the size and depth of your macular hole. As a macular hole develops, your vision will seem blurred and straight lines may look wavy and distorted, so that you have difficulty reading small print for example. You may even notice a small blank patch in the centre of your vision.



What treatment is available for macular hole?

If your ophthalmologist feels you need treatment for your macular hole, they will usually suggest an operation to treat it. 

Surgery for macular hole

Surgery aims to improve your vision by closing the macula hole. There are two main stages to the treatment:

  • Surgery to remove the vitreous and insert a gas bubble into the eye.
  • A recovery period when the gas bubble left inside your eye acts like a bandage, creating an environment that encourages your macular hole to close.

Will surgery help my vision?

In many cases, surgery can stop your blurred and distorted vision from getting worse and can help your sight to improve. For some people this can be to a high standard. In the months that follow surgery, 80-90 per cent of people have some degree of improvement in their vision, but this can depend on the size and age of the macular hole and what level of vision was present before surgery. If your macular hole is closed early enough, ideally within a few months of being diagnosed, your vision might improve by two or three lines of letters, sometimes more, on the sight test chart. 

There have even been some cases where treatment of more longstanding macular holes has led to visual improvement. As the outcome of treatment can vary from person to person, your ophthalmologist will be able to discuss with you how they hope you will benefit from surgery, depending on all aspects of your eye health and the stage of your macular hole.

Whenever you have your surgery, even if your vision doesn’t improve much, it’s likely to stabilise and give you less distortion. For a minority of people, vision can worsen after surgery which may lead your ophthalmologist to suggest a second operation. They will be able to discuss with you how they hope you will benefit from surgery depending on the health of your eye and stage of your macular hole.

It can take several months after surgery for the eye to fully recover and for someone to know just how much vision they have re-gained. Most of the eye recovery and vision improvement occurs within the first three months after surgery.

Possible complications after macular hole surgery

In the majority of cases, macular hole surgery has a high success rate, but a successful outcome will also depend on your individual circumstances and other aspects of your eye health.

All surgery carries some risk of complications, and within macular hole surgery, if a complication develops, there are treatments available. For this reason, it is rare for someone to lose vision due to complications following macular hole surgery. However, your ophthalmologist will advise you on what the possible complications are and the chances of them happening to you. Complications from macular hole surgery include cataractraised eye pressure, infection, retinal detachment and bleeding.

Positioning face down (posturing) after surgery

Some people are advised to maintain a face-down position for a period of time following surgery. This is to improve the chances of a better outcome by keeping the floating gas bubble in contact with the macular hole for as long as possible. Although face-down positioning might improve the outcome for larger macular holes, most can be successfully repaired without the need for uncomfortable positioning.

The length of time you’re recommended to maintain a particular head position each day, and for how many days can also vary, but it is usually between three days and a week. Your ophthalmologist can discuss with you what they feel is best in your case and whether you need to position your head face down at all.

There is more information about positioning face down (posturing) and how to prepare for it in our factsheet which you can download from the link at the top of this page.

What activities can I do after surgery?

After surgery, you can usually go back to your general everyday activities once you have finished positioning face down. However, most people are advised not to return to work for at least a couple of weeks after surgery. Your ophthalmologist is best placed to advise you exactly how long to take off in your case. This will depend on the type of work you do and also on how you recover.

You may also need to avoid the following activities for the first few weeks, or as advised by your ophthalmologist, after surgery:

  • Rubbing your eye. You may be asked to wear an eye patch or shield when you are sleeping to protect your eye.
  • Swimming, to avoid infection from the water while your eye is healing.
  • Strenuous exercise, contact sports and heavy lifting. Everyday lifting like light shopping is usually fine, but heavy lifting like moving furniture is best avoided. 
  • Wearing eye makeup, until the hospital are happy for you to do so.
  • Flying or travelling to high altitude on land, until your gas bubble has fully absorbed, which can take up to 12 weeks. The gas bubble expands at high altitude, causing very high pressure in your eye which can cause permanent sight loss.

It is unlikely that your vision will be good enough for you to safely drive while you have a gas bubble in your eye. While you are legally entitled to drive if the vision in your other eye is good enough to meet the driving standard, many ophthalmologists think that it’s unwise to do so while the bubble remains in your eye. Ask your ophthalmologist for advice about driving after your surgery.

You will usually see your ophthalmologist about two or three weeks after the operation to check that your macular hole is healing. At this appointment, you can ask about returning to all your usual activities, including your work, depending on how your eye is recovering.

Will I need to get my glasses changed?

Most people will need to change their glasses at some point after their operation, usually when the gas bubble has completely gone about three months after surgery. Your ophthalmologist will be able to advise you as to when you can visit your optometrist (optician) for a new glasses prescription. 

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Can I do anything to avoid or improve a macular hole?

There is nothing you can do to avoid getting a macular hole and it doesn’t develop because of anything you’ve done. Diet and exercise haven’t been found to make macular hole more likely.

Having an eye examination at least every one to two years, as advised by your optometrist, is the best way to make sure your eyes are healthy and that no new eye conditions are developing. There is nothing you can do to fix a macular hole yourself and, in most cases, treatment is required as recommended by your ophthalmologist.



Coping

Being diagnosed with an eye condition can be very upsetting. You may find that you are worried about the future and how you will manage with a change in your vision. All these feelings are natural. We’re here to support you every step of the way, and to answer any questions you may have – just get in touch with our Sight Loss Advice Service

Many people who have macular hole surgery have some visual improvement afterwards in that eye. However, if your vision remains reduced after your surgery, there are lots of things you can do to make the most of the vision you still have. A low vision assessment can explore how to make the most of your sight. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. Your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment. You can also find out tips for making the most of your sight by downloading our guide:



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