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Macular Hole

The macula is the part of the retina that is responsible for vision in the central field of view. It is also responsible for distinguishing color. When the macula becomes detached from the rest of the retina, acute vision loss can occur. When a hole occurs, it commonly only happens in one eye.

There are three stages of a macular hole, each with increasing severity of vision loss. Stage I is foveal detachment; half of all cases will progress. Stage II is a partial-thickness hole; 70% will progress. Stage III is a full-thickness hole; this stage has the most severe vision loss.

The macula is attached to the vitreous humor, the jelly substance that fills the eye and gives it its shape. As the eye ages, the humor begins to shrivel. It begins to pull on the back of the retina and, if it is attached firmly enough, it could pull part of the macula with it. This hole can then fill with liquid, causing distorted vision. Because of this, macular holes are most common among senior citizens. If this is the reason for the hole, there is a chance that the hole may occur in the other.

Other causes for a macular hole include diabetes, myopia, retinal detachment, or head trauma.

Central vision loss is the most common symptom of a macular hole. Other areas may appear blurred. Close vision tasks, such as reading or recognizing faces. Additionally, straight lines may appear curved.

Some early stage macular holes can heal themselves. Later stage holes need surgery if vision is to be returned. Excess liquid is removed from the back of the eye. A bubble is inserted into the eye that holds the macula back in its place. After the surgery the patient must remain in a face down position from anywhere between two days to three weeks to allow the macula to heal itself. The earlier the macular hole is caught, the better chance the surgery has for success. Unfortunately, cataracts and retinal detachment may be side effects of the surgery.