4 Macular Hole Stages: Protect Your Vision with Early Intervention

what does my vision look like with a macular hole

What Does My Vision Look Like With a Macular Hole

Macular Hole Stages

Overview:

What is macular hole?

The macular hole is a defect or lesion extending from ILM (internal limiting membrane) deep down to the RPE (retinal pigment epithelium). As the macula is responsible for keeping the central vision intact. Any pathology at the region of macular will lead to central vision loss. Depending upon the macular hole stages, the severity of vision impairment can be graded. It is a condition in which fellow eye can be involved with a risk of other eye involvement at 5 years in around 10% cases The article will discuss the causes, signs and symptoms, macular hole stages and available treatment options, prevention, outlook and prognosis.


Causes:

What Are The Causes Of Macular Hole?

  • The macular hole is most common in the female population.
  • High myope
  • Vitreomacular traction
  • History of blunt ocular trauma
  • Retinal detachment
  • History of any eye surgery

Signs and Symptoms:

What are the signs and symptoms of macular hole?

In full-thickness macular patients may present with central vision loss, however in partial-thickness macular hole complaints of metamorphopsia may be noted.


Macular Hole Stages

Macular Hole Stages

What are the macular hole stages?

In the past the classification of macular hole stages was made on the basis of VMT (vitreomacular traction), as it is believed to be one of the leading causes of macular hole. However, a new classification on the basis of OCT has been postulated.

Stage 0: It denotes the oblique foveal vitro retinal traction before the appearance of clinical picture (IVTS = VMA (vitreomacular adhesion)

Stage 1: This stage is subdivided into two types.

1a: Impending macular hole (IVTS = VMT (vitreomacular traction). In this stage there is flattening of foveal depression with underlying yellow spot.

1b: occult macular hole. It is seen as a yellow ring. The yellow ring appearance is due to displacement of photoreceptors in centrifugal pattern.

In stage 1, the visual loss is usually not significant.

Stage 2: Small full thickness hole (IVTS=small or medium FTMH with VMT)

It consists of macular hole of less than 400 ums in diameter. The defect is central so the vision is affected centrally. In this stage the patient complaint of the straight lines appearing as bend or distorted.

Stage 3: Full size macular hole (IVTS= medium or large FTMH with VMT). The full thickness macular hole is more than 400um in diameter. The hole appears as red base with yellow white dots in the center. The visual acuity may be reduced to 6/60.

Stage 4: Full size macular hole with complete PVD (IVTS= small, medium or large FTMH without VMT).

Clinically it is difficult to distinguish from stage 3. The posterior vitreous is completely detached. In this stage, the macular hole is the largest and most severe. There is a significant loss of vision, and a blind spot may be present in the central vision.


Diagnosis and Tests:

How is a macular hole diagnosed?


The diagnosis of macular hole stages is made on slit lamp ophthalmoscopy. However other tests include.

Amsler grid: The test will signify central distortion.

The Watzke- Allen test: This test is performed by projecting a vertical and horizontal beam of light with slit lamp. Patient with macular hole will report that the beam is thinned or broken.

OCT (optic coherence topography): It is the most useful test for the diagnosis and staging of macular hole.

FAF (fundus autofluorescence): The test shows markedly hyperfluorescent foveolar spots in stage 3 and 4 and punctate fluorescence in stage 2.

FA (fluorescence angiography): This test signifies macular hole as a window defect due to displacement of xanthophyll’s and RPE atrophy.


Management and Treatment

Is there any treatment for macular hole?

The treatment for a macular hole depends on the stage and severity of the condition. In some cases, such as stage 1 macular hole may heal on its own. However, in more severe cases, surgery may be necessary. Surgery is performed in stage 2 or more severe cases. Vitrectomy surgery, which involves removing the vitreous gel and replacing it with a gas bubble, may be performed to repair the macular hole


How to perform macular hole surgery?

The macular hole surgery consists of vitrectomy together with ILM (internal limiting membrane peeling) with the help of a dye. Induction of PVD is done to remove tractional forces. Gas tamponade is implanted in place of the vitreous. After the surgery patient is advised to lie in face down position


What is the prognosis of macular hole surgery prognosis?

The macular hole is usually healed up to 100% of the cases. However visual improvement may take months in 80-90% eyes. the visual outcome is 6/12 or better in 65% of the cases, while a worse prognosis is labeled in 10% of cases.


How is the macular hole surgery recovery?

The time of recovery depends upon the stage of the macular hole and early surgical intervention.


What are the options for macular hole treatment without surgery?

The only option for the macular hole to heal without surgery is spontaneous recovery unless the macular hole stages are in stage 1.


How much the macular hole Surgery cost?

The cost of macular hole surgery can vary depending on several factors, such as the geographic location, the surgeon’s experience, and the specific surgical technique used. The cost will include the surgeon’s fees, facility fees, anesthesia fees, and follow-up visits. However, it’s essential to note that insurance coverage can vary, and some insurance plans may cover part or all of the cost of the surgery. However, the whole rates of the surgery can be confirmed from your health professional.


Prevention

There are no specific preventive measures for macular holes. However, regular eye exams can detect the condition in its early stages, allowing for earlier treatment and a better prognosis.


Outlook/Prognosis

The outlook for macular hole stages depends on the stage and severity of the condition. In the early stages, there may be no significant loss of vision, and the hole may heal on its own. However, in more severe cases, vision loss may be permanent, even with surgery. The overall prognosis is generally better when the condition is detected early and treated promptly.

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Conclusion

Macular holes can have a significant impact on vision and quality of life. If you are experiencing any symptoms of a macular hole, it is important to seek medical attention as soon as possible. With early detection and treatment, the prognosis for macular holes can be positive, but in more severe cases, vision loss may be permanent. Regular eye exams are essential in detecting the condition early and ensuring prompt treatment.


FAQ

  1. What are the early signs of macular hole?

    In the early stage, the patient complained to have distorted vision and straight lines appearing bent. Some patients may report central vision loss as an early sign.

  2. How serious is a macular hole?

    In the early stage of macular hole e.g., in stage 1, it is benign and can resolve spontaneously. However, stage 2,3,4 can have serious outcomes if not treated well on time.

  3. Does macular hole lead to blindness?

    The macular hole will not lead to complete blindness however central vision loss may be markedly reduced.

  4. How urgent is macular hole surgery?

    In the advanced stage of the macular hole, surgery should be performed within 6 months of the commencement of the macular hole.

  5. Can macular hole be corrected with glasses?

    The macular hole defect cannot be corrected with glasses, as it is a macular pathology with a field defect.

  6. What age does macular hole occur?

    A macular hole is not directly related to the age of the patient however any associated pathology may lead to the early development of a macular hole such as any traction force, high myopia, or trauma.

  7. Do macular holes run in families?

    Macular hole is not a genetic condition and it does not run in families.

  8. Can you live with a macular hole?

    Macular hole may cause a central field defect, it is easy for the patient to live with macular hole if he can cope with the field defect.

  9. How to treat macular hole naturally?

    A less severe form of macular hole will heal on its with time. However, in more severe cases with marked vision loss, help should be taken from a health professional for early surgery.

References

  1. American Academy of Ophthalmology. (2021). Macular Hole. Retrieved from https://www.aao.org/eye-health/diseases/macular-hole-cause-symptoms-treatment
  2. National Eye Institute. (2021). Facts About Macular Holes. Retrieved from https://nei.nih.gov/health/macularhole/macularhole
  3. NHS. (2019). Macular Hole. Retrieved from https://www.nhs.uk/conditions/macular-hole/
  4. Yan, J., Wang, M., Chen, Y., & Zhang, X. (2018). The Classification and Staging of Idiopathic Macular Hole. Journal of Ophthalmology, 2018, 8152154. doi: 10.1155/2018/8152154
  5. Verywell Health. (2021). How Much Does Macular Hole Surgery Cost? https://www.verywellhealth.com/how-much-does-macular-hole-surgery-cost-5072884
Dr Sadia Ayaz
Dr Sadia Ayaz

I am an ophthalmologist and eye surgeon

Articles: 47

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