Macular hole

A macular hole is a very different eye condition from macular degeneration, even though they both affect the macula. For this reason, they are treated differently to each other.

This page contains a summary of our information on macular hole. To read our full information, download our factsheet:

Often there is no known reason why someone develops a macular hole. They are more common between the ages of 60 and 80 and women experience them more often than men. It has been linked to:

• being slightly long-sighted (slight hyperopia)
• being very short-sighted (high myopia)
• having a severe eye injury
• having had a retinal detachment
• having long lasting macular swelling (cystoid macular oedema)
• your vitreous gel pulling on the macula (vitreomacular traction).

Macular hole affects your central vision and depending on its size and depth, these vision changes can range from being only slight to being more noticeable. As a macular hole develops, your central vision will become more blurred and straight lines may look wavy and more distorted, so that you have difficulty reading small print for example. You may even notice a small blank patch in the centre of your vision.

If your ophthalmologist feels you need treatment for your macular hole, they will usually suggest an operation to treat it.

Surgery for macular hole

Surgery aims to improve and stabilise your vision by closing the macula hole. There are two main stages to the treatment:

• Surgery to remove the vitreous (vitrectomy) and insert a gas bubble into the eye.
• A recovery period when the gas bubble left inside your eye acts like a bandage, creating a stable environment for the macula to encourages your macular hole to close.

Will surgery help my vision?

In many cases, surgery can stop the changes in your vision from getting worse and can help your sight to improve. In the months after surgery, 80-90 per cent of people have some degree of improvement in their vision. However, this can depend on the size and age of the macular hole and what level of vision you had in that eye before surgery.

As the outcome of treatment can vary from person to person, your ophthalmologist will be able to discuss the benefits of surgery in your case, taking into account your overall eye health and the stage of your macular hole.

It can take several months after surgery for the eye to fully recover and for someone to know just how much vision they have re-gained. Most of the eye recovery and vision improvement occurs within the first three months after surgery.

Possible complications after macular hole surgery

In most cases, macular hole surgery has a high success rate, but a successful outcome will also depend on your individual circumstances and other eye conditions you may have.

All surgery carries some risk of complications, and within macular hole surgery, if a complication develops, there are treatments available. For this reason, it is rare for someone to lose vision due to complications following macular hole surgery. However, your ophthalmologist will advise you on what the possible complications are and the chances of them happening to you. Complications from macular hole surgery include cataract, raised eye pressure, infection, retinal detachment and bleeding.

Positioning face down (posturing) after surgery

Some people are advised to maintain a face-down position for a period following surgery. This is to improve the chances of a better outcome by keeping the gas bubble in contact with the macular hole for as long as possible to encourage healing.

Your ophthalmologist can discuss with you what they feel is best in your case and whether you need to position your head face down at all. If it is recommended, ophthalmologists usually advise positioning face down for a certain amount of time each day for around three to seven days, but this may vary from person to person. If you’ve been advised to position face down after your surgery, maintaining this posture can be an important part of your recovery.

There is more information about positioning face down (posturing) and how to prepare for it in our factsheet, which you can download from the link at the top of this page.

What activities can I do after surgery?

After surgery, you can usually go back to your general everyday activities once you have finished positioning face down. However, most people are advised not to return to work for at least twoweeks after surgery. Your ophthalmologist is best placed to advise you exactly how long to take off in your case. This will depend on the type of work you do and also on how you recover.

After surgery, you may also need to avoid the following activities for the first few weeks, or as advised by your ophthalmologist:

• Rubbing your eye. You may be asked to wear an eye patch or shield when you are sleeping to protect your eye.
• Swimming, to avoid infection from the water while your eye is healing.
• Strenuous exercise, contact sports and heavy lifting. Everyday lifting like light shopping is usually fine, but heavy lifting like moving furniture is best avoided.
• Wearing eye makeup, until the ophthalmologist is happy for you to do so.
• Flying or travelling to high altitude on land, until your gas bubble has fully absorbed, which can take up to 12 weeks. The gas bubble expands at high altitude, causing very high pressure in your eye which can cause permanent sight loss.
• It is unlikely that your vision will be good enough for you to safely drive while you have a gas bubble in your eye. While you are legally entitled to drive if the vision in your other eye is good enough to meet the driving standard, many ophthalmologists think that it’s unwise to do so while the bubble remains in your eye. Ask your ophthalmologist for advice about driving after your surgery.

There is nothing you can do to avoid getting a macular hole and it doesn’t develop because of anything you’ve done. Diet and exercise haven’t been found to make macular hole more likely.

Having an eye examination at least every one to two years, as advised by your optometrist, is the best way to make sure your eyes are healthy and that no new eye conditions are developing. There is nothing you can do to fix a macular hole yourself and, in most cases, treatment is required as recommended by your ophthalmologist.

It’s completely natural to be upset when you’ve been diagnosed with a macular hole, and it’s normal to find yourself worrying about the future and how you will manage with a change in your vision. All these feelings are natural. We’re here to support you every step of the way, and to answer any questions you may have – just get in touch with our Sight Loss Advice Service.

Many people who have macular hole surgery have some visual improvement afterwards in that eye. However, if your vision remains reduced after your surgery, there are lots of things you can do to make the most of the vision you still have. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see. You can also find out tips for making the most of your sight by downloading our guide: