In the early stages of a macular hole formation, central vision is blurry and distorted. As the hole grows larger, a blind spot develops and central vision further deteriorates. Peripheral vision is not affected.
In most cases a macular hole develops as a result of anatomical changes that occur naturally. As a person ages, the vitreous gel inside the eye shrinks and pulls away from the macula. In a small percentage of individuals, the resulting mechanical stress causes the macular tissue to stretch and tear, forming a hole. Traumatic eye injury and chronic swelling can also cause a macular hole to form. A retinal exam and retinal imaging studies such as fluorescein angiography and optical coherence tomography are used to confirm the presence of a macular hole.
Vitrectomy surgery (removal of the vitreous gel that fills the eye) is necessary for the treatment of most macular holes. A gas bubble is placed inside the eye to help close the hole and keep it in place while healing occurs. Visual outcome is variable and depends on factors such as the size of the macular hole and how long it has been present.