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Macular Hole

A macular hole is a small, circular gap which opens at the centre of the retina, causing blurred vision and distortion where straight lines appear wavy.

What is a Macular Hole?

The back of the eye has a light-sensitive lining called the retina, like the film in a camera. Light is focused through the eye onto the retina, allowing us to see. The centre part of the retina is called the macula – it is here that light must be focused for us to see fine detail, to be able to read and see in colour.


We do not know why macular holes develop.

They most often occur in people aged 60-80 and is twice as common in women as men

We are increasingly aware that it is mainly slightly long-sighted people who are affected

Other causes of macular holes include severe trauma to the eye

Being very short-sighted (myopic)

Those who have had a retinal detachment or because of longstanding swelling of the central retina (cystoid macular oedema)

[British and Eire Association of Vitreoretinal Surgeons – Macular Hole, see]


Blurred central vision and distortion, where straight lines appear wavy.

In the majority of patients, the central vision will gradually get worse to a level where the patient is unable to read even the largest print on an eye test chart.

The condition does not affect the peripheral vision, and so patients will not go completely blind from this condition.


If untreated, there is a small chance, about 1 in 10, that some macular holes can close spontaneously, with improvement in vision.   Careful examination can assess the risk of developing a macular hole in the other eye. Your surgeon will tell you your risk, but this may be from extremely unlikely to a 1 in 10 chance. It is very important to monitor for any changes in vision of the fellow eye, and report these to your eye specialist/family doctor/optician urgently.

A macular hole can often be repaired by an operation called a vitrectomy, peel & gas. If the hole has been present for less than a year, the operation will be successful in closing the hole in about 90% of cases. Of these, more than 70% will be able to see two or three more lines down a standard vision chart, compared to before the operation. Even if this degree of improvement does not occur, the vision is at least stabilised, and many patients will find that they have less distortion. In a minority of patients, who often have very large macular holes, the hole does not close despite surgery and the central vision can continue to deteriorate; however, a second operation can still be successful in closing the hole. It is important to understand that return to completely normal vision is not possible and that vision improvement depends on factors other than purely closure of the hole, particularly the condition of the light-sensing retinal cells (photoreceptors).

[British and Eire Association of Vitreoretinal Surgeons – Macular Hole, see]

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