Macular Hole

The macula is the very small area in the back of the retina that is responsible for providing sharpness and clarity in our vision. This detailed vision is necessary for daily tasks such as reading, driving, and watching television. A jelly-like substance called the vitreous fills the central portion of the eye.

It is composed of 99% water, some chemicals to create the gel, and long protein fibers. As we age the vitreous begins to shrink. The jelly starts to break down and the protein fibers start to aggregate. In most people the vitreous eventually separates from the retina in a process called posterior vitreous detachment.

In some people the vitreous may remain adherent to the central portion of the macula and pulling by the vitreous can cause bad things to happen to the macula. Chronic pulling, or traction, on the macula can cause the macula to become distorted or stretched. In some people the force of the traction exceeds the mechanical strength of the macula and a hole can form.

Macular holes are typically very small – smaller in diameter than a pin. However the macula is very important for sharp vision and even a very small hole can cause important visual problems. The vision is generally decreased and distorted.

The curious aspect of macular holes is that they don’t heal themselves. If someone had their ears pierced, but didn’t wear an earring the hole would close. Only the smallest macular holes can close without surgery and even then the chance is low. The retina is really a type of brain tissue, and brain tissue doesn’t heal well. The steps naturally taken by the body to heal a macular hole can make it get larger over time.