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Treatment Specialty
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Macular Hole
A macular hole is a disorder in which the center portion of the retina, which is called the macula, develops a hole. The macula is the portion of the retina that is responsible for your ability to see small fine print, to read, and to do detail work. When a hole develops in this area it results in a reduction in you central vision, which can be mild to sever depending on how large the hole is and how long it has been present.
Macular holes go through four different stages, in early stages (stage 1 and 2) patients may notice only a slight distortion or haziness in their vision. Lines may look bent or crooked and in later stages (Stage 3 and 4) central vision is blurred
and detailed vision can be lost.
Macular hole can best be seen on a cross sectional image of the retina which can be obtained using Optical Coherence Tomography. A normal retina appears in image 1, whereas a macular hole can be seen in image 2.
Macular holes are seen usually in people over age of 60 without any other eye diseases. However, macular holes can be associated to eye disorders such as nearsightedness (high myopia), macular pucker, trauma, diabetes and retinal detachments.
Usually macular hole affects only one eye,
but in up-to 15 percent of time the other
eye maybe affected.
Only a small percentage of stage 2, 3, and 4 macular holes can heal on their own, the majority will need surgery to improve vision. Surgery is often on an out-patient basis with local anesthesia. In general, once you have a stage 2, 3, or 4 macular hole, you are better off having surgery
within four to six weeks. Typically, the longer you wait the less likely you are to get you vision back. Visual recovery for macular holes that are over a year old tends to be less than those that are only a few weeks old.
Surgery for macular holes involves removing the material in the center of the eye
called the vitreous gel. In most cases the tissue on the surface of the retina called the internal limiting membrane and other associated membranes are also removed. The gel is then replaced by a gas bubble. The gas bubble presses against the retina/macula and helps to close the macular hole. It is important to maintain a face-down position after surgery to improve the success of the hole closure, and because this position can be difficult it is important that you discuss this with your physician at the Retina Health Center before surgery. Following surgery you will not be able to fly for up to 12 weeks, depending on what type of gas is used. During air travel the pressure in the plane is typically less than at ground level, and this will cause the bubble to expand and the pressure in the eye to go up which can result in vision loss. If you have a macular hole, it is best to see a doctor promptly and to have it treated within a few weeks to insure you get as much vision back as possible.
Macular Pucker
A Macular Pucker is a thin tissue that is similar to the skin of an onion or a piece of plastic wrap that has developed over the central portion of the retina, the macula.
There are other names that can be used for this condition including epireti-
nal membrane, wrinkled retina, pre-reti-
nal fibrosis, or scar tissue. 
The condition
can result in decreased vision, and distortion of your vision. Straight lines can appear wavy. This is a result of the tissue contracting, distorting, and thickening the retina. These changes can best be seen on a cross sectional image of the retina which can be obtained using Optical Coherence
Tomography.
Normal retina appears in image 1, whereas a thickened and distorted retina due to a macular pucker can be seen in image 2. The distorted line on top of the image represents the macular pucker. This condition is most common in patients over the age of 50. Most of the time it affects one eye, however it may affect the other eye at a later stage. Macular puckers are more common when other conditions are present such as diabetes, inflammation, and trauma. Severe visual loss from macular pucker is rare, most of the time patients may notice blurred or distorted vision that can be mild to moderate with slow progression. Most of the time when symptoms are mild treatment is not needed.
If visual distortion and blurriness limits reading or everyday activity then a surgical procedure may be recommended. The surgical procedure consists of vitrectomy with removal of the scar tissue. Surgery can restore vision and improve distortion in most people, however it may not return to normal. You need to discuss with your physician at RHC about whether surgical treatment is appropriate.
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