Macular Hole

A macular hole is relatively common.  While total blindness is  not common, severe, permanent vision loss can occur.  Prompt referral and treatment by an experienced retina specialist can help restore your vision.

Why do Macular Holes Occur ?

Macular holes usually arise from pulling or traction on the central retina, called the macula.  Over time, and with enough pulling, a piece of the macula can pop off—much like the top of a soup can.

Symptoms of a Macular Hole

You may notice a blind spot in your central vision, or sometimes a crookedness or break in straight lines.  Over time, the blind spot can bigger, and the vision declines.

In general, the bigger the macular hole, the worse the vision.

Diagnosis of a Macular Hole

While larger macular holes can be readily diagnosed just by examination, smaller, or earlier stages, can be subtle.

An experienced retina specialist can use different examination techniques, including pictures of the eye, to determine what is happening.

Based on the examination, your macular hole can be divided into different stages.  Stage 4 usually refers to the largest, most complete type.  Lower stages, however, can still impact your vision.

Treatment of Macular Holes

Depending on the stage, and certain other factors, injection of a medicine, called Jetrea, can be tried, but only once.

The other treatment is a vitrectomy, where the clear jelly fluid of the eye is removed.  A delicate membrane peel is performed. The eye is then usually filled with a gas bubble.

Depending on your retina surgeon’s experience and comfort level, you may be advised to try keep your head facing down for some time.  I usually just advise a few days, as tolerated.

You can order certain devices to make the post operative period easier on your back and neck.


In the hands of an experienced retina specialist, the prognosis for improvement of vision after macular hole surgery is good.  You should discuss with your retina specialist his or her methods, and success rates.


Nader Moinfar, M.D., M.P.H., F.A.C.S.
Retina Specialist
Lakeland | Winter Haven
Zephyrhills | Lake Mary

Jon Doe