Powered By
Continue with Facebook
Continue with Email
Have you ever tried to read something, but the words in front of you seemed blurry, warped, or like parts were missing? Or have you looked at an image and noticed that straight lines looked bent or wavy?
These vision changes can have several causes. Sometimes, they may be a sign of an eye condition called a macular hole.
A macular hole affects the macula. It’s part of the retina, the light-sensitive tissue at the back of the eye. The macula helps you see sharp details straight ahead, called central vision. A macular hole can cause changes in central vision, potentially making everyday activities like reading or driving more challenging.
Age-related macular degeneration (AMD) can also affect central vision, but it’s a different condition. AMD happens when aging damages the macula, whereas a macular hole is a defect in the macula. Understanding the symptoms, causes, and treatment options can help you know when it’s time to see an eye care specialist.
Here’s what you need to know about macular holes, including how they’re different from AMD.
The macula is the part of your eye in the center of your retina. The retina takes in light, sending it along the optic nerve to be processed by the brain into images. It’s located in the back part of your eye.
There are two parts of the retina that allow you to see:
A macular hole is a defect — such as a break or opening — that affects the full thickness of the macula. This can reduce its ability to process details in the center of your vision.
Most macular holes are caused by aging. As you age the vitreous humor — the gel-like substance inside your eye — gradually pulls away from the retina. If the vitreous gel remains attached to one part of the retina while pulling away from another, it can cause vitreous traction — pulling on the retina that puts stress on the macula. This pulling can cause a hole to form.
Macular holes are more likely to affect people who are 55 or older. According to the Cleveland Clinic, they tend to occur more often in women than in men.
When a macular hole forms due to age alone, a retina specialist may call it a primary macular hole.
Less commonly, a macular hole can develop due to:
Doctors call these secondary macular holes.
Macular holes and AMD both affect the macula and both commonly develop in people over 50.
Although these eye conditions have some similarities, there are several ways in which they’re different.
Both macular holes and AMD affect the macula. Because of this, both conditions can affect your central vision, causing symptoms such as:
Although macular holes and AMD can cause similar symptoms, these two disorders develop in different ways.
A macular hole is a defect in the macula, which typically only affects one eye.
AMD involves gradual damage to the macula that happens over time. In the most common type of AMD, dry AMD, light-sensing cells break down as drusen — small yellow deposits beneath the retina — build up.
Dry AMD may affect one or both eyes at a time, leading the macula to become thin and dry. Central vision loss tends to happen slowly. People with dry AMD may notice blurry central vision or trouble seeing in low lighting.
Wet AMD, which is less common, occurs when abnormal blood vessels grow in the back of the eye and damage the macula. These fragile vessels may leak fluid or blood into or under the retina, which can cause swelling or lift the macula from its normally flat position.
Over time, leaking can lead to scarring. Vision loss can progress quickly with wet AMD, so prompt diagnosis and treatment are important to help protect central vision.
Most people who develop a macular hole are treated with a procedure called a vitrectomy. This surgery — performed by an ophthalmologist who specializes in retina procedures — is reported to be successful in 9 out of 10 people.
During a vitrectomy, a surgeon removes the vitreous humor and any other tissues putting stress on your macula. The gel is often replaced with a gas bubble to allow the hole to heal.
Although it’s possible to get most of your eyesight back after a vitrectomy, this is more likely to happen when the procedure is performed on a small or newly formed macular hole.
If your macular hole is small, your eye doctor may recommend waiting to perform the procedure to see if the condition heals on its own. They also may recommend certain eye drops that can increase the likelihood that the macular hole will close without surgery.
On the other hand, AMD can’t be treated as easily. Current AMD treatments are aimed at slowing the rate of damage and reducing symptoms. Treatment options for AMD include nutritional supplements, laser and light therapies, and eye injections.
AMD often causes eyesight to slowly worsen over time. Although people with AMD may experience severe vision loss, it’s rare for the condition to cause someone to go blind. Gradual worsening of central vision due to AMD may make it hard for you to perform daily activities such as:
Without treatment, a macular hole can cause vision loss — most often, the central vision. Other possible complications that can result from not treating the condition include enlargement of the hole and, in very rare cases, retinal detachment (when the retina pulls away from its normal position at the back of the eye).
Having a vitrectomy to treat a macular hole also comes with its own set of risks that may affect your vision, including:
As one myAMDteam member noted, “I have early dry macular degeneration in both eyes. I did have surgery several years before I was diagnosed because I had a macular hole in my left eye.”
This led them to question whether their macular hole could have had anything to do with their AMD: “Did having a macular hole cause, or is it related to having AMD?”
Since a macular hole affects the same part of the eye as AMD, it’s natural to wonder if having one makes you more likely to develop AMD. The answer to this is no. Although several factors can put you at a higher risk of developing AMD, having a macular hole isn’t one of them.
According to the Cleveland Clinic, factors known to increase your risk of AMD include:
It’s possible to have both a macular hole and AMD. However, current evidence suggests this overlap isn’t common.
One study that looked at 27,912 people with dry or wet AMD reported macular holes were found in less than 1 percent of eyes. Macular holes developed more often in people with dry AMD (1.1 percent) compared to wet AMD (0.3 percent).
A small study found that partial-thickness macular holes, called lamellar macular holes, were present in 3.3 percent of eyes with AMD. Among the eyes with both conditions, most also had late-stage wet AMD.
Although macular holes and AMD can coexist, it’s important to note that they’re distinct conditions and having one doesn’t make you more likely to develop the other.
On myAMDteam, people share their experiences with age-related macular degeneration, get advice, and find support from others who understand.
Have you ever had a macular hole? Did it heal on its own or did you need a vitrectomy? Let others know in the comments below.
Get updates directly to your inbox.
Continue with Facebook
Continue with Email
Continue with Facebook
Continue with Email
Become a member to get even more
Join
Your Privacy Choices
This is a member-feature!
Sign up for free to view article comments.
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.