“Dr. Paul Lagonigro and team gave me confidence. Grateful to Dr. Joseph Schwartz for surgery and Atlantic Retina team for excellent care.”
Macular Hole: Protecting Your Central Vision
Who Gets Macular Holes
Macular holes are more common than many people realize, and certain individuals face a higher risk. Understanding the risk factors can help you stay alert to early symptoms and seek evaluation at the right time.
Macular holes most commonly affect people over the age of 55. Women are affected more often than men. In studies of patients who required surgery for macular holes, approximately three out of four patients were women, and the average age at diagnosis was in the early sixties.
If you have had a macular hole in one eye, there is a real chance the other eye could be affected as well. Research shows that roughly 10 to 15 percent of people who develop a macular hole in one eye will develop one in the other eye within five years. For this reason, our Retina Specialists closely monitor both eyes, not just the affected one.
While most macular holes develop without a clear outside cause, several factors are known to increase risk.
- High myopia, or severe nearsightedness, which stretches the retina and increases tension on the macula
- Eye injury or blunt trauma, which can cause macular holes even in younger individuals
- Related eye conditions such as macular pucker (epiretinal membrane), retinal detachment, and diabetic retinopathy
If any of these factors apply to you, discussing routine retinal monitoring with a Retina Specialist is a wise step.
Symptoms to Watch For
Macular hole symptoms develop gradually, which means many people are not aware of the problem until the hole has grown. Knowing what to look for can lead to earlier diagnosis and better outcomes.
In the early stages, symptoms are often subtle. You might notice slight distortion when looking straight ahead, or straight lines may appear bent or wavy. Fine print may become harder to read, and you may notice that individual letters disappear or seem blurry in the center of a line of text.
As the hole grows larger, symptoms become harder to ignore. A blurred or dark spot may appear in the center of your vision. You may be able to see a person standing in front of you but struggle to make out their facial features. Side vision typically stays normal throughout this process, which is why the condition can go unnoticed for longer than it should.
Because macular holes usually affect one eye at a time, your stronger eye naturally compensates, masking the problem. Many people do not realize anything is wrong until the affected eye is tested on its own. A simple way to check is to cover each eye separately while looking at a grid or printed page. If lines look wavy, distorted, or missing in one eye, that is a reason to contact a Retina Specialist promptly.
How Macular Holes Are Diagnosed
Diagnosing a macular hole requires a thorough retinal exam combined with specialized imaging. Our team uses advanced in-office technology to detect, stage, and monitor macular holes with precision.
A Retina Specialist can detect a macular hole during a dilated eye exam. Dilating drops widen the pupil so the retina and macula can be seen in full detail. During this exam, the specialist looks for the characteristic opening in the macula and evaluates its size, stage, and surrounding tissue.
Optical coherence tomography, commonly called OCT, is the most important imaging test for macular holes. OCT uses light waves to create highly detailed, cross-sectional images of the retina, allowing our Retina Specialists to measure the exact size of the hole and assess how the surrounding retinal layers are affected. The scan is completely painless and takes only a few minutes. We perform serial OCT imaging at every visit, which helps our team track any changes in the hole over time.
An Amsler grid is a simple chart with a grid of straight lines and a dot in the center. When you focus on the dot, wavy, distorted, or missing areas in the grid can signal a problem with the macula. Our Retina Specialists may ask you to use this grid at home between appointments to help monitor any changes. While it is not a substitute for a professional exam, it is a practical way to stay aware of your vision between visits.
Treatment Options
The right treatment for a macular hole depends on its stage, size, and how long it has been present. Our Retina Specialists review every case individually and recommend the approach most likely to restore your central vision.
For very small, early-stage holes with mild symptoms, a Retina Specialist may recommend close observation before recommending surgery. Some early macular holes can stabilize on their own, and in rare cases, a small hole may even close without intervention. Regular OCT imaging allows our team to track any progression and determine the right time to act.
Vitrectomy is the primary surgical treatment for most full-thickness macular holes. During this procedure, the Retina Specialist removes the vitreous gel from inside the eye and carefully peels away a thin membrane from the surface of the macula called the internal limiting membrane (ILM). Removing the ILM relieves the traction pulling on the macula and significantly improves the likelihood that the hole will close.
After the vitreous and surface tissue are removed, the surgeon fills the eye with a gas bubble. This bubble presses gently against the macula to support healing. The gas dissolves on its own over several weeks. Vitrectomy has a high success rate for closing macular holes, and most patients recover meaningful central vision after the procedure. Smaller holes that are treated sooner tend to have the best outcomes.
Ocriplasmin (brand name Jetrea) is an enzyme that can be injected into the vitreous to dissolve the proteins holding the vitreous against the macula. It received FDA approval for treating vitreomacular adhesion and may be considered for smaller macular holes where the vitreous is still pulling on the macula. Clinical studies have shown that a meaningful percentage of treated eyes achieved nonsurgical hole closure, which is significantly higher than in untreated eyes.
This option is not appropriate for every case. A Retina Specialist will evaluate whether ocriplasmin is suitable based on the specific characteristics of your macular hole.
For large macular holes or those that do not close with standard vitrectomy, additional surgical techniques are available. One approach involves creating a small flap from the internal limiting membrane and folding it into the hole to act as a scaffold that supports healing. This technique, sometimes called an inverted ILM flap procedure, has shown strong results in closing difficult holes. Your Retina Specialist will discuss which approach best fits your situation.
What to Expect From Surgery and Recovery
Understanding what lies ahead makes the recovery process much easier to navigate. Vitrectomy for macular hole is a well-established outpatient procedure, and our team will guide you through every step from preparation to final follow-up.
Before scheduling vitrectomy, your Retina Specialist will perform a thorough exam and OCT scan to confirm the details of the hole. You will receive specific instructions about medications to pause, when to stop eating and drinking before surgery, and how to arrange transportation home. Vitrectomy is performed on an outpatient basis, meaning most patients return home the same day.
Vitrectomy is typically performed under local anesthesia with sedation, and the procedure generally takes about one hour. After surgery, you may notice mild discomfort, redness, or light sensitivity. Vision will be very blurry at first because the gas bubble inside the eye temporarily blocks light from reaching the retina normally. This is expected and will improve as the bubble gradually dissolves.
One of the most important parts of recovery is positioning. After surgery, your Retina Specialist may ask you to keep your head in a face-down position for a period of several days to weeks. This keeps the gas bubble in contact with the macula, allowing it to heal properly. The required duration varies depending on the size and characteristics of the hole. Special pillows, chairs, and mirror glasses designed for face-down recovery are widely available and can make this period much more comfortable.
The gas bubble typically dissolves over two to eight weeks, depending on the type of gas used. As it clears, vision gradually improves. Most patients notice meaningful changes within a few months, though full visual recovery can take up to a year. It is essential to avoid air travel or high altitudes while the gas bubble is still present, as changes in air pressure can cause serious complications. Your Retina Specialist will tell you when it is safe to fly.
The amount of vision recovered depends largely on the size of the hole and how long it was present before treatment. Smaller holes treated promptly generally have the best outcomes. Some patients may notice mild residual distortion even after successful closure, but overall vision is typically much better than before surgery.
Living With a Macular Hole
Whether you are waiting for treatment, recovering from surgery, or monitoring your other eye, a few practical steps can help protect your vision and quality of life. Our team supports you throughout every phase of care.
Given the 10 to 15 percent risk of developing a macular hole in the fellow eye within five years, ongoing monitoring is an important part of long-term care. Our Retina Specialists will schedule regular follow-up exams and OCT scans to watch for early changes. Checking your vision at home with an Amsler grid, testing each eye separately, adds another layer of awareness between office visits. Any new distortion or central blind spot should prompt a prompt call to our office.
While waiting for treatment or recovering from surgery, there are practical ways to cope with reduced central vision. Magnifying devices, large-print reading materials, and brighter lighting can make reading easier. Adjusting font sizes and screen brightness on phones, tablets, and computers also helps. If vision loss is more significant, a low-vision rehabilitation specialist can provide personalized tools and training.
Some symptoms require immediate evaluation and should not be waited on. Contact a Retina Specialist right away if you experience any of the following.
- A sudden increase in floaters or a shower of new floaters
- Flashes of light in your vision
- A curtain, shadow, or dark veil spreading across your visual field
- Sudden vision loss in one eye
These symptoms may indicate a retinal tear or detachment, which is a medical emergency separate from a macular hole. Prompt treatment in these cases can mean the difference between preserving and losing vision.
Frequently Asked Questions
Here are answers to questions we hear often about macular holes. Each answer is meant to add practical guidance beyond what is already covered above.
It is possible in rare cases for a very small, early-stage hole to close on its own, but this cannot be relied upon. Most full-thickness macular holes will not close without treatment, and waiting too long reduces the chances of a good visual outcome after surgery. If a Retina Specialist is monitoring your hole without immediately recommending surgery, it means your case has specific features that make observation reasonable, not that the hole will simply go away. The decision to watch versus treat should always be guided by a specialist.
The required duration varies widely depending on the size of the hole and your surgeon's protocol. Some smaller holes may require only a few days of strict face-down positioning, while larger holes may require up to two weeks. The positioning does not need to be perfectly maintained every second, and brief breaks for meals and hygiene are usually permitted. Talking with your Retina Specialist about a specific schedule before surgery helps you plan ahead and arrange any equipment or help you may need at home.
No, it is not safe to fly while a gas bubble is present inside the eye. The drop in cabin pressure that occurs during air travel causes the gas to expand rapidly, which can cause a dangerous rise in eye pressure and potentially serious complications. The restriction typically lasts until the gas has fully dissolved, which can take several weeks depending on the type of gas used. Your Retina Specialist will confirm when flying is safe again, and it is important to inform any other treating physicians about the gas bubble if you need surgery or anesthesia for any reason during recovery.
An untreated macular hole tends to enlarge over time, causing progressive worsening of central vision in the affected eye. Side vision typically remains intact, but activities that rely on sharp central vision, including reading, driving, and facial recognition, become increasingly difficult. The longer a hole remains open and untreated, the less likely surgery is to fully restore vision. Early treatment consistently produces better outcomes than delayed intervention.
In the majority of cases, a macular hole that has been closed by vitrectomy remains closed permanently. However, there is a small chance that a hole can reopen, particularly in eyes with very large holes or other complicating factors. Regular follow-up appointments with a Retina Specialist allow for early detection if reopening occurs, and additional treatment can be considered promptly. This is one of the key reasons why continued monitoring after surgery is recommended even when recovery goes well.
Many patients find that their vision improves significantly after surgery but does not return completely to what it was before the hole developed. You may still benefit from updated glasses once vision has stabilized, which usually takes several months to a year after surgery. In some cases, mild distortion or a subtle reduction in contrast may persist even after the hole is closed. A Retina Specialist can refer you for low-vision services or updated optical correction once your vision has fully stabilized.
Schedule Your Evaluation at Atlantic Retina Center
If you are experiencing distortion, blurring, or a blind spot in your central vision, our team at Atlantic Retina Center is here to help. Our fellowship-trained, board-certified Retina Specialists serve patients throughout the Delmarva peninsula with the advanced imaging, surgical expertise, and compassionate care needed to address macular holes at every stage. We would be honored to be your partner in protecting your vision for years to come.