Macular hole

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

A macular hole is a small hole 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. Similarly, a macular hole is not the same as a retinal hole and is treated differently.

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?
– Is there anything I can do 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: 

  • being slightly long-sighted (slight hyperopia)
  • being very short-sighted (high myopia)
  • having a severe eye injury
  • having had a retinal detachment
  • having long lasting macular swelling (cystoid macular oedema)
  • your vitreous gel pulling on the macula (vitreomacular traction). 


How does a macular hole affect vision?

If you develop a macular hole you will probably notice changes in your central vision. 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.

There are different stages to a macular hole. These stages relate to the size of the hole. Your ophthalmologist (hospital eye doctor) will identify the stage of your macular hole and advise you about your treatment. It’s possible that an early stage macular hole will heal itself. Around 50 per cent of stage 1 holes heal without treatment once the vitreous has fully separated from the macula. If your macular hole is at stage 1, your ophthalmologist may want to monitor things for a few months before recommending any treatment.

Most macular holes carry on developing and distorting vision if they are bigger than stage 1. In general, the bigger your macular hole is, the more difficult it will be for you to read down the letter chart. Macular hole treatment attempts to close the macular hole and to improve your vision as much as possible.

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What treatment is available for macular hole?

If your ophthalmologist feels you need treatment for your macular hole, they may suggest either an injection or, more usually, an operation. Your ophthalmologist will advise you as to the best treatment for you.  

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 up to a high standard. In the months that follow surgery, 80-90 per cent of people have some improvement in their vision. However, how much visual improvement you gain from your surgery can depend on how big your macular hole is, how old it is and what level of vision you had before surgery.

If your macular hole is closed early enough, your vision can improve by two or three lines of letters, sometimes more, on the sight test chart. However, it’s unlikely that your vision will be quite as good as it was before your macular hole developed. 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 but it’s possible to have a second operation which may be successful in closing your macular hole. Your ophthalmologist 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 ultimately how much vision they have re-gained. Most of the eye recovery and vision improvement occurs within the first 2-3 months after surgery.

Possible complications after macular hole surgery

Macular hole surgery has a high success rate. All surgery carries some risk of complications, but with macular hole surgery, the risk rate is low and if a complication develops there are treatments available. For this reason it is rare for someone to lose vision following macular hole surgery due to complications. Complications from macular hole surgery include cataractraised eye pressure, infection, retinal detachment and bleeding.

Posturing after surgery

In the days after your surgery, to ensure the gas bubble can do its job, you may be asked to position your head in such a way that allows the gas bubble and your macular hole to be in contact for most of the time. This could mean that you’re advised to be in a face down position. This part of the process is often called “posturing”. Not everyone is asked to posture in the same way or to the same extent after their surgery. There is more information about what posturing involves and how to prepare for posturing 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 everyday activities once you have finished posturing. You may 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 need time off work to recover and your ophthalmologist is best placed to advise you how long to take off. This may depend on the type of work you do and also on how you recover.

Usually, you will see your ophthalmologist about 2-3 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, 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). 

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Is there anything I can do to avoid or improve a macular hole?

There is nothing you can do to avoid getting a macular hole. Your diet and exercise haven’t been found to make macular hole more likely. Having an eye test at least every two years 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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