A macular hole is a hole in the central portion of the retina, the macula. The macula is like the "bull's eye" of the retina. It is the part of the eye responsible for seeing fine detail such as letters on a page, numbers on a telephone or the ball in a tennis match. Macular holes occur most frequently in healthy people, most of whom are women in their 60's and 70's.

This top photograph shows the normal macula appearance. You can see the round retinal defect in the center of the macula, surrounded by a white halo, which corresponds to a local area of retinal detachment around the edges of the hole.

The inside cavity of the eye is filled with a gel called the vitreous, similar to how air fills the inside of a basketball. Macular holes occur when the portion of the vitreous that lies on the macula spontaneously contracts, pulling some macula with it. If the pulling is strong enough, a hole develops and a small area of retinal detachment causing loss of fine vision.

How is a macular hole treated?

In rare cases, the macular hole closes on its own resulting in improved vision. In severe Stage 3 & 4 cases, doctors will perform vitrectomy surgery. They removes the vitreous gel or fibrous membrane which causes the pulling leading to a macular hole. A temporary gas bubble is placed in the eye to seal the hole. The bubble is then absorbed by the body over 10 - 14 days and is replaced by normal salt water produced by the eye. The gs bubble then puts pressure on the macula, inducing the hole to flatten and close. Part of the healing process for the patient involves lying face down for approximately ten days.

Until recently, the success rate for repairing macular holes was only 50 percent. New developments using a dye called indocyanine green and a new instrument developed by Yasuo Tano in Japan made from microdiamond dust allows the tissue causing the macular hole to be removed with success rates approaching better than 95%.

In hard to close macular holes' a new procedure using autologous serum - blood drawn from a patient's own body ­ in conjunction with surgery, significantly improves the outcome for patients. We apply this method to cases that we think would benefit the patient. Dr. Liggett was the lead investigator on a macular hole research study examining this technique. For more information about the study, click here.