What is a macular hole?
The macula is a small area (about 5mm) found in the middle of the retina, the light-sensitive layer that lines the back of your eye. It allows us to see fine details needed for things like reading, watching TV or threading needles. When a gap forms in this part of the retina, it’s known as a macular hole.
What are the symptoms of a macular hole?
People with macular holes tend to notice a change in their central vision, usually in one eye. Things might look blurry or distorted, or you could feel like you have a blind spot in the centre of your vision. Some people say that straight lines look bent (distortion), letters appear ‘jumbled up’ when reading or it’s just more difficult to read, watch TV or carry out close-up tasks.
Symptoms can vary quite a bit depending on the size of the macular hole.
What causes a macular hole?
In most cases, a macular hole develops due the natural ageing process within the eye. The vitreous (the gel-like substance that fills your eye) is attached to the retina with lots of very tiny fibres. With age, the vitreous starts to naturally shrink, which means that some of these fibres pull away from the retina. In some cases, this process can create a tiny hole in the macula.
Sometimes, it isn’t quite clear why macular holes develop. They’re rarely associated with other eye-related conditions, including:
Severe short sight (called myopia)
How is it diagnosed?
If you ever notice the symptoms associated with a macular hole, it’s important that you see your optometrist as soon as possible for an eye exam. If they spot any signs of a macular hole, they’ll refer you on to specialists like us to do some more tests.
When we’re looking for macular holes, we use eye drops to dilate the eye so we can get a really clear view of the back of your eye and use what’s known as an OCT scan to see the structures of your retina in detail, which helps us to find the macular hole. If we do find something, we’ll be able to determine the right treatment for you, whether that’s with surgery or ongoing monitoring.
What treatment is there for a macular hole?
Macular holes rarely seal themselves and occasionally your consultant will recommend ongoing monitoring. In a lot of cases, surgery is needed to repair the hole and help improve vision.
The surgery is known as a vitrectomy and involves removing the vitreous and filling the eye with a special gas bubble. The macular hole heals behind the gas bubble which gradually disappears in around two to four weeks.
What are the benefits of macular hole surgery?
The main benefit is that it preserves the central vision in your eye. Without treatment, it’s very likely that the macular hole will become chronic, which means that it can have a permanent effect on your central, detailed vision. Timely treatment within weeks to a few months is the most successful way to treat a macular hole and achieve the best possible results.
What happens during macular hole surgery?
Before your procedure, your consultant will fully assess your eye health. Some people will have cataract surgery at the same time (because it’s common for cataracts to develop after vitrectomy), in which case you’ll also have what’s called a biometry test to make sure your replacement lens is the right one for you. Your consultant will go through all the details of your procedure and can answer any questions you might have.
Vitreoretinal surgery is a relatively straightforward procedure that normally takes between 30-40 minutes. Most vitreoretinal operations are performed under a local anaesthetic, either by eye drops or anaesthetic around the eye. So don’t worry, there won’t be any needles. You might just see a bright light and some movement, but you won’t be able to feel a thing. We know this can be a bit unnerving, but our theatre teams will be there to make sure you’re feeling completely comfortable the whole way through. Your surgeon will talk you through everything they’re doing.
As the procedure is carried out with local anaesthetic, you’ll be able to go home the same day.
You won’t be able to drive home afterwards so make sure you have someone to take you home. We also recommend having someone who you can call for about 24 hours after your procedure, in case you need a bit of help once you get home.
Part of the surgery involves putting a bubble of gas in your eye – so it’s really important that you don’t travel by air or climb high altitudes until the gas is absorbed, which could take between two to four weeks. Your consultant will talk you through everything you need to know about this before you go home.
How long does it take to recover from macular hole surgery?
In general, it takes between six to eight weeks to fully recover from surgery and for your vision to start improving. In the week or so after your procedure, the gas bubble starts to absorb, and the eye fills back up with the fluid it naturally produces. It’s normal for your vision to be very poor when the bubble is large, but it will gradually improve as it absorbs.
What are the possible complications?
Although the vast majority of patients won’t experience any complications, as with all surgery there are some risks of complications. Our team will discuss these with you in detail at your appointment and will make sure you’re happy to go ahead with treatment.
How much does macular hole surgery cost?
Private vitreoretinal surgery starts from £5,995 per eye and combined vitreoretinal and cataract surgery starts from £6,995 per eye. That includes all your pre- and post-operative appointments, as well as your medication.
If you have any questions about available treatments or you’d like to book an appointment with a full assessment of your condition, get in touch with us.
When does vision return after macular hole surgery?
Vision is usually much better after the gas bubble has cleared (after two to four weeks).
Can a macular hole be cured?
A macular hole is usually treated with surgery. Occasionally they can heal on their own without surgery, your ophthalmologist might just want to keep an eye on it for a while to make sure surgery isn’t needed.
How do I get referred?
Your optician or GP will discuss the various treatment options available to you and where you can choose to have your treatment. You’ll be able to take the time to decide where you’d like to be treated, and your optician or GP will make the arrangements for your referral to Newmedica.
If you’re a private patient, you can just get in touch with us directly. But if you’re using private medical insurance, you might need some more information to make your claim. You can find all the details on our private referral page.
Find your nearest clinic
Building 720, Waterside Drive, Aztec West, Almondsbury, Bristol, BS32 4UD
29-30 Market Place, North Ormesby, Middlesbrough, TS3 6HR
Tottle Road, Riverside Business Park, Nottingham, NG2 1RT
Unit 2, Anchorage Ave., Shrewsbury Bus. Park, Shrewsbury, SY2 6FG
Getting referred to Newmedica
If you think you have an eye condition, you should see your optician or GP for a detailed assessment. They’ll go through all the options available and tell you where you can have your treatment.
The referral process will differ slightly depending on whether you want to be an NHS or private patient. You’ll find all the information you need on our NHS and private patient pages.
Are you a health care professional?
Find out how to refer a patient.