Macular hole

What is a macular hole?

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. 

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How does macular hole affect my vision?

A macular hole affects your central vision, making it distorted and blurred so that it’s more difficult for you to do things like read and watch television. You may also have a blank patch in the centre of your vision. However, you won’t lose all your vision and it isn’t painful. In general, the bigger your macular hole is, the more difficult it will be for you to read down the letter chart.

What is the treatment for macular hole?

Macular hole treatment attempts to close the macular hole and to improve your vision as much as possible. If your macular hole is small, your ophthalmologist (hospital eye doctor) may want to monitor things for a few months before recommending any treatment. If your ophthalmologist feels you need treatment for your macular hole, they may suggest either an injection or, more usually, an operation. The operation involves removing the vitreous gel from inside your eye and replacing it with a gas bubble. This gas bubble creates an environment that encourages your macular hole to close. Your ophthalmologist will advise you as to the best treatment for you.  

If I have surgery, what happens next?

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.

What activities can I do after macular hole surgery?

After surgery, you’ll need time off work to recover and your ophthalmologist can advise you how long to take off. You must not fly or travel to high altitude on land until your gas bubble has fully absorbed which can take up to 12 weeks. This is because the gas bubble expands at high altitude causing very high pressure in your eye which can cause permanent sight loss.

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

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