Macular hole

A small hole in the centre of the retina, distorting and blanking central vision. Surgery works, and works better the sooner it is done.

What it is

A small full-thickness hole in the macula, the part of the retina responsible for detailed central vision.

It usually happens because the vitreous gel inside the eye shrinks with age and pulls on the macula. It affects mainly people over 60, more women than men, and usually one eye.

It causes distortion and then a blank or grey patch in the centre of vision, while peripheral vision remains normal, so the person can still walk about but cannot read, recognise faces or drive.

**It is treatable, and time matters.** Surgery, a vitrectomy with a gas bubble, closes the hole in the large majority of cases, and the visual result is substantially better in holes operated on within a few months than in those left for a year or more. Delay therefore costs vision permanently.

It is frequently confused with macular degeneration, which is a different condition with different treatment, and the distinction is made by a scan called OCT, available in most high street optician practices.

Face-down posturing after surgery is required in many cases, sometimes for several days, and it is demanding.

The other eye develops a hole in around 10 per cent of cases, so symptoms in the second eye need prompt assessment.

Signs you might notice

Distortion of central vision: straight lines appearing wavy or bent.

A grey or blank patch in the centre of vision.

Difficulty reading, recognising faces, or seeing detail.

Objects appearing smaller or larger in the affected eye.

Peripheral vision unaffected.

Gradual over weeks to months, painless.

Urgent, and different: sudden loss of vision, flashes and floaters, or a curtain across vision, which suggests retinal detachment and needs same-day care.

Any new distortion or central blur should be assessed within days by an optometrist or eye clinic, not left for a routine appointment.

Cover each eye in turn to check; one good eye masks the problem completely.

How it can affect day-to-day life

Losing central vision in one eye is often not noticed for weeks because the other eye compensates. Checking each eye separately, using an Amsler grid, is how people catch it and how they monitor the second eye.

The face-down posturing after surgery is genuinely hard: hours a day for several days, needing equipment, sleep adaptations and help at home. Planning it in advance, and hiring the specialist chair and headrest, makes it manageable.

While a gas bubble is in the eye, flying and travelling to altitude are forbidden, and nitrous oxide anaesthesia must be avoided. A wristband is given and must be shown to any clinician.

Cataract almost always develops or worsens after vitrectomy, and usually needs surgery within a year or two. Knowing that in advance stops it feeling like a complication.

Vision improves slowly over months rather than immediately.

Low vision services, magnifiers and lighting advice help considerably during and after.

Supporting someone well

Check each eye separately, regularly, particularly after 60 and if the other eye has been affected.

Use an Amsler grid at home; distortion of the lines is the earliest sign.

Get new distortion or central blurring assessed within days by an optometrist; ask for an OCT scan.

Do not delay surgery; earlier operations give better vision.

Plan the posturing in advance: equipment, help at home, and time off.

Carry the gas bubble wristband and tell every clinician; no flying and no nitrous oxide.

Expect cataract afterwards and ask about the plan for it.

Expect gradual improvement over months.

Ask for low vision assessment and registration if vision remains poor.

Where to get help

A high street optometrist for an OCT scan and urgent referral.

The hospital eye service for surgery.

Same-day eye casualty for sudden vision loss, flashes or a curtain.

Macular Society on 0300 3030 111, and RNIB on 0303 123 9999.