As people age, vitreous, a gel-like substance in the eye, contracts and pulls away from the surface of the retina. Usually, this brings about changes no more noticeable than a few floaters and no significant damage. For some people, however, this shift in vitreous can cause small holes to occur in the macula at the center of the retina called macular holes. As the vitreous becomes less like jelly in texture, it begins to seep through the hole and cause a dark spot or defect. This results in a loss of or distorted central vision.
Macular holes can be divided into three stages of severity:
Stage one is called foveal detachment; 50 percent of cases worsen when not treated at this stage.
At stage two, there is partial-thickness; 70 percent of cases worsen without treatment.
Stage three is known as full-thickness. At this stage, patients experience severe central vision loss.
The stage of the condition also influences symptoms, which include distorted or wavy vision, blurred central vision, difficulty executing detail tasks such as reading, and a central blind spot or gray area.
Holes that go all the way through the macula are typically treated using a surgical procedure called a vitrectomy. This involves taking away the vitreous in order to stop it tugging on the retina. The vitreous is then replaced with a gas bubble that fills with the natural fluids produced by cells in the front of the eye over a six- to eight-week period. Patients must keep their faces down for two to three weeks to allow the bubble to press against the macula and seal the hole.
Macular holes usually appear spontaneously, and there is no chemical or nutritional way known to prevent their development. Similarly, there is no way to know who is at risk of developing the condition, as it is rarely caused by trauma or injury to the eye. The best way to avoid vision problems related with macular holes, therefore, is to be aware of the symptoms and seek treatment as early as possible.: