The macula is located in the centre of the retina. It is the area of the retina containing the largest concentration of cones. It is due to this concentration that the macula enables us to read, drive and do all the tasks requiring clear and detailed vision.
A macular hole is a small rupture of the macula which shows up in the form of a dot. The appearance of this dot in turn causes the disappearance of photoreceptors where the dot is.
The early stage of the disease is characterised by a moderate drop in visual acuity with perception of deformed images (“metamorphopsias”).
When the macular hole is fully formed the drop in vision becomes significant.
Macular holes generally affect people of over 60 years of age, predominantly females.
Macular holes are generally caused by vitromacular traction. The inside of the eye is made up of the vitreous body. This is attached to the surface of the retina. With age, the vitreous body tends to retract and consequently detach from the retina. It can damage this and cause the appearance of a macular hole.
There are other causes of macular holes, like short-sightedness, detached retina, diabetic retinopathy or an eye injury.
Macular holes often appear progressively. It may be that the macular hole closes spontaneously.
If one eye has a macular hole, it is possible that the other develops one as well. There is a 10 to 15% probability.
On examining the back of the eye, a round or oval foveolar hollow is observed, surrounded by a halo of retinal lifting. At the bottom of the hole, there are sometimes little white deposits.
This disease can be analysed by an angiography, but even better by an optical coherence tomography (OCT).
No treatment can prevent macular holes.