|A macular hole is a full-thickness defect in the macula, the part of the retina that is critical for central reading vision. A macular hole causes a slowly-progressive decrease in central vision. Initially, a macular hole will cause waviness or distortion to one’s central reading vision eventually leading, in most instances, to a central blind spot and significantly decreased vision. Macular holes are caused by abnormal pulling on the central macula by the vitreous gel that normal exists inside the eye. Macular holes are most commonly seen in those over the age of 60. Women tend to be more affected by macular holes than men. Unfortunately, full-thickness macular holes never close on their own. Vitrectomy surgery is required to improve vision although complete recovery is rarely achieved even after a successful procedure. Typically, most visual recovery will occur in the first three months following surgery. Incremental improvements in vision may be appreciated as far out as one and a half years post-operatively. Delays in surgical repair of a macular hole will often limit visual recovery.|| Surgery requires the placement of a gas bubble within the eye and may require one to maintain a “face down” head position for one to two weeks post-operatively to maximize contact of the bubble with the macular hole and help close the retinal defect. There are no alternatives to surgery. Over 90% of macular holes will close after surgery. It is possible, especially with larger and more long-standing macular holes, that a second surgery may be required.
Macular Pucker or Epimacular Membrane
|A macular pucker or epimacular membrane consists of scar tissue that forms overlying the macula, or central part of the retina, and causes waviness and distortion to one’s central reading vision. Not all macular puckers lead to visual disability and some patients remain asymptomatic. Macular puckers, however, will never resolve on their own. Macular puckers are often formed as a consequence of a posterior vitreous detachment (PVD). A PVD is an age-related phenomenon whereby the get that exists inside the eye contracts and detaches from the retina.||Vitrectomy surgery is required in order to improve one’s vision. Micro-forceps are used during surgery to gently peel the scar off from the surface of the macula. Visual recovery after surgery takes months and usually does not require the placement of an air or gas bubble within the eye. Patients often notice a moderate improvement in vision after surgery but rarely return perfectly back to normal.|
Posterior Vitreous Detachment
|Posterior vitreous detachment (PVD) is an age-related process whereby the gel that exists inside the eye contracts and collapses from the lining of the retina. Symptoms of flashing lights and floaters in one’s vision are appreciated when a PVD occurs. Most concerning, PVD is often the initiating event in the creation of a retinal tear. Patient’s experiencing symptoms consistent with a PVD should be examined carefully for the development of a retinal tear that, if not diagnosed and promptly treated by a retina specialist, can lead to the development of a retinal detachment.
After a PVD occurs, your retina specialist will likely perform a dilated eye examination which includes pressing on the side of the eye to carefully search for a retinal tear. Often times, patients may note a varying but stable degree of floaters in one’s vision after a PVD.