Frequently Asked Questions about Macular Holes and Macular Hole Repair   What is a macular hole?   A macular hole is a defect in the macula. The macula is a tiny oval area made up of millions of nerve cells located at the center of the retina. It is responsible for what you see straight ahead: your sharp, central vision. If you were able to look into someone’s eye through the pupil (the black hole in the middle of the colored part of your eye) you would be looking directly at the macula in the back of the eye. What causes a macular hole?   Shrinking of the vitreous, a jelly-like substance that fills the eye, usually causes the hole. As a normal part of the aging process, the vitreous begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result from the traction. Some macular holes are caused by a thin layer of tissue which forms over the macula during the vitreous aging process. This tissue is called an epiretinal membrane, but is also known as a retinal pucker or wrinkle. What are the symptoms of a macular hole?   The size and severity of the hole determines how much it will affect vision. Generally, people notice distortion and blurred vision. However, if the hole goes all the way through the macula, you can lose a lot of your central and detailed vision. Difficulty reading is often the first sign of a problem and is what brings someone to an eye care professional. Is a macular hole the same as macular degeneration?   No, although they both have similar symptoms, they are two different diseases and are treated very differently. How is a macular hole treated?   Macular holes are treated with an outpatient surgical procedure called vitrectomy. If an epiretinal membrane is present, the tissue is gently lifted and removed. The vitreous is removed to prevent it from pulling on the retina and is replaced with a gas bubble. The bubble fills the eye and its gentle pressure on the macula helps the hole to seal. Macular hole surgery is dependent not only on the skill of the surgeon but also the commitment of the patient to post operative instruction. Following surgery, patients must maintain face down positioning which allows the gas bubble to rise and press against the macula and seal the hole. Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment. How successful is this surgery?   The surgery is about 90 percent effective in closing the hole with proper head positioning following surgery. However, improvement in people's vision is more variable. More than half of those who have the surgery can expect an improvement of two lines or more on the vision chart. Will I get at least partial benefit from the surgery if I can’t keep my head down?   The success of macular hole surgery is largely dependent on your ability to keep the gas bubble correctly on the macula where it can maintain constant gentle pressure. Since the gas rises, this is only possible when the head is in a face-down position. It is impossible to remain face-down 100% of the time; however, each hour spent in this position increases the likelihood of successful surgery. Our equipment is available to help you stay as comfortable as possible while maintaining correct positioning. What can I expect after surgery?   While the bubble is at its full size your vision will be blurry. As the bubble dissipates over the weeks following surgery your vision will improve. It is not uncommon to have some discomfort and a scratchy feeling. Your doctor will advise you of the appropriate pain reducing techniques for you. Deep ache or throbbing pain that does not respond to Tylenol or other over the counter pain relievers should be reported to your doctor. Redness is common and will gradually lessen over time. You will be restricted from flying until the gas bubble has been completely resorbed. High elevations can cause the bubble to expand beyond a safe size and pressure for the health of the eye.