A macular hole affects the centre of the retina and can progressively impair the sharp, detailed vision needed for reading, recognising faces and other everyday activities. Early diagnosis and appropriate treatment are important to close the hole, improve central vision and reduce the risk of further visual loss.
A macular hole is a small opening that develops in the macula, the central part of the retina at the back of the eye. The macula provides the sharp, detailed vision needed for activities such as reading, recognising faces and driving.
Macular holes most commonly develop as part of the natural ageing process. The eye contains a clear, gel-like substance called the vitreous, which gradually shrinks and separates from the retina over time. If the vitreous remains attached to the macula and pulls on it, a small opening may form.
Certain factors are associated with a higher risk of developing a macular hole, including:
Macular holes most commonly develop in one eye, but there is also a risk of the condition developing in the other eye. We will examine both eyes carefully and use detailed retinal scans to assess the macula and identify any changes that require monitoring or treatment.
A macular hole can cause blurred or distorted central vision, with straight lines appearing wavy and a dark or missing area in the centre of vision. Reading, recognising faces and seeing fine details may become more difficult.
A macular hole can cause blurred or distorted central vision, with straight lines appearing wavy and a dark or missing area in the centre of vision. Reading, recognising faces and seeing fine details may become more difficult.
Any new distortion, blurring or loss of central vision should be assessed promptly. During your consultation, we will examine the retina and perform detailed imaging to determine whether a macular hole is present and whether further monitoring or treatment is required.
We use a combination of detailed eye examination and advanced retinal imaging to assess the macula, retina, optic nerve, and retinal blood vessels. These tests allow us to identify structural and functional changes, determine the type and severity of the condition, and establish a clear baseline for ongoing monitoring and treatment planning.
Measures how clearly you can see and helps identify any reduction in central vision.
Captures detailed images of the retina and macula to document the appearance and location of the macular hole.
Provides detailed cross-sectional images of the macula to identify macular holes, assess their size and extent, and evaluate changes in the surrounding retinal layers.
Maps the central visual field to identify areas of reduced or missing vision associated with the macular hole.
A small or early macular hole may occasionally close without treatment. In selected cases, regular monitoring with retinal imaging may therefore be recommended. If the hole enlarges or if your vision deteriorates, surgery may be required.
When a macular hole affects central vision, vitrectomy surgery is performed to remove the pulling forces that keep the hole open. Vitrectomy is usually performed as an outpatient procedure, with no overnight hospital stay required. During surgery, fine microsurgical instruments are introduced through tiny openings in the eye, while the eye is maintained with a clear sterile fluid. The vitreous gel is removed, followed by careful peeling of the internal limiting membrane to reduce tension around the macula and allow the retinal tissue to come together.
A temporary gas bubble is then placed inside the eye to support the macula while the hole heals. Face-down positioning is required so the bubble rests against the macular hole and helps keep the tissue together. The gas bubble gradually becomes smaller and is naturally replaced by fluid produced within the eye. Depending on the type of gas used, it can remain in the eye for approximately two weeks to three months. In selected more complex cases, silicone oil can be used instead of gas to provide longer-term support. Unlike gas, silicone oil does not dissolve on its own and requires a separate procedure for removal.
After surgery, we will monitor the eye closely with follow-up examinations and OCT scans to assess how the macula is healing and track changes in vision. Recovery is gradual, and the retina continues to settle over the weeks and months following surgery.
From your initial consultation to treatment and follow-up care, our team will guide you through every stage of your journey. We will take the time to explain your condition, answer your questions and help you feel informed and supported throughout your care.
Your consultation begins with a detailed assessment of your vision and eye health. Depending on your condition, this may include measurements of your vision and eye pressure, examination of the front and back of the eye, and advanced diagnostic imaging.
Our team will guide you through each test and explain what is being assessed. Your results will then be carefully reviewed to understand your individual needs and determine whether monitoring or treatment may be recommended.
Every eye and every patient is different. Your treatment plan will be tailored according to your examination findings, visual needs, general health and lifestyle.
We will explain the recommended treatment, its expected benefits, possible risks and any suitable alternatives in a clear and straightforward manner. You will have time to ask questions and consider your options before deciding how you would like to proceed.
Before your treatment, our team will guide you through the necessary preparations, paperwork and medication instructions. Where applicable, we will explain how to use your prescribed eye drops and how to care for your eyes afterwards.
We understand that undergoing a procedure can feel unfamiliar or worrying. Our team will be available to answer your questions and ensure that you know what to expect before the day of your treatment.
On the day of your procedure, you will arrive at the hospital or surgical centre where your operation has been scheduled. The surgical team will help you prepare and explain what will happen at each stage.
Anaesthetic eye drops or other forms of anaesthesia may be used, depending on the procedure, to keep you comfortable. Your doctor and the surgical team will support and reassure you throughout the operation.
Most eye surgeries are performed as day procedures, although the duration and recovery process will depend on the treatment you receive. Your vision may be temporarily blurred afterwards, so you should arrange for someone to accompany you home and should not drive unless your doctor has advised that it is safe to do so.
We will provide clear instructions on how to care for your eyes, use any prescribed medication and manage your activities during recovery. We will also explain which symptoms are expected and when you should contact the clinic for further advice.
Follow-up appointments allow us to monitor your vision, assess your recovery and identify any concerns at an early stage. Our team remains accessible should you have any questions or concerns throughout your recovery.
If you have noticed blurring, distortion or a missing area in the centre of your vision, a detailed retinal assessment can help determine the cause.
Book a consultation at Ascend Eye Clinic for a comprehensive examination and advanced retinal imaging. We will explain your findings clearly and discuss whether monitoring or treatment is recommended.
A macular hole affects the centre of the retina, which is responsible for sharp, detailed vision. It commonly causes blurred or distorted central vision, difficulty reading or recognising faces, and a small missing or dark area in the centre of vision.
Yes. A macular hole can enlarge over time, with increasing disruption to central vision. Earlier assessment allows us to determine the size and stage of the hole and whether treatment should be performed before further visual deterioration occurs.
No. A macular hole is a physical opening that develops at the centre of the macula, whereas age-related macular degeneration involves progressive changes to the macular tissue. They are separate retinal conditions with different causes and treatments.
Most macular holes develop when the vitreous gel inside the eye changes with age and pulls on the centre of the retina as it separates. If this traction is strong enough, it can create a small opening in the macula.
Yes. Macular holes occur most commonly in adults over the age of 50 because age-related changes in the vitreous increase the likelihood of traction developing at the macula.
Yes. Highly short-sighted eyes are longer in shape and experience greater stretching of the retina. This increases the risk of several macular conditions, including macular holes.
Yes. Significant blunt trauma to the eye can produce sudden forces across the retina and lead to a traumatic macular hole. These can occur in younger patients as well as older adults.
Most macular holes initially affect one eye. However, the other eye has an increased risk of developing a macular hole, particularly when certain vitreous changes are present. We will therefore examine and scan both eyes during assessment and follow-up.
We examine the retina and perform optical coherence tomography, or OCT, which provides detailed cross-sectional images of the macula. OCT allows us to confirm the diagnosis, measure the size of the hole and assess the surrounding retinal tissue.
Small, early macular holes occasionally close without surgery, particularly when the traction causing the hole releases naturally. Established full-thickness macular holes are much less likely to close spontaneously and are generally treated with vitrectomy surgery.
No. Treatment is based on the size, stage and appearance of the hole, the level of vision affected and whether vitreous traction is still present. Small early holes can sometimes be monitored closely, while established full-thickness holes are generally treated surgically.
Once an established macular hole is confirmed and surgery is recommended, treatment should not be unnecessarily delayed. Smaller and more recent holes generally have a better chance of anatomical closure and visual improvement than holes that have been present for a long time.
Yes. Successful surgery closes the macular hole in the large majority of cases and often improves central vision. The amount of visual recovery depends on factors such as the size and duration of the hole and the condition of the retinal tissue before surgery.
The hole often begins closing during the early healing period while the gas bubble supports the macula. We monitor closure using OCT scans during follow-up. Visual recovery continues more gradually over the following weeks and months as the macula heals.
Vision is blurred immediately after surgery, particularly while the gas bubble remains inside the eye. Patients often notice a moving line in their vision as the bubble gradually becomes smaller. Vision improves progressively as the bubble disappears and the retina heals.
The initial recovery usually takes several weeks, although the retina continues to heal for several months. We will review the eye regularly, monitor closure of the macular hole with OCT scans and advise when normal activities can be resumed safely.
This depends on the type of work and how the eye is recovering. Light daily activities can usually be resumed relatively early, while strenuous exercise, heavy lifting, swimming and other higher-risk activities should be avoided during the initial healing period. We will provide specific guidance during follow-up.
Vitrectomy increases the rate at which cataracts develop in patients who still have their natural lens, particularly in older adults. Cataract progression is therefore common after vitrectomy and can be treated with cataract surgery when it begins to affect vision.
Recurrence after successful closure is uncommon. We continue to monitor the macula after surgery to confirm that the hole remains closed and to assess the recovery of the retinal tissue.
Yes. The fellow eye has a higher risk of developing a macular hole than the general population. We will examine both eyes and use OCT imaging where appropriate to monitor the vitreous and macula for early changes.
