Re: OT: Macular Tear

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A macular hole is a small break in the macula, located in the center of the

eye's light-sensitive tissue called the retina. The macula provides the

sharp, central vision we need for reading, driving, and seeing fine detail.

A macular hole can cause blurred and distorted central vision. Macular holes

are related to aging and usually occur in people over age 60.

Most of the eye's interior is filled with vitreous, a gel-like substance

that fills about 80 percent of the eye and helps it maintain a round shape.

The vitreous contains millions of fine fibers that are attached to the

surface of the retina. As we age, the vitreous slowly shrinks and pulls away

from the retinal surface. Natural fluids fill the area where the vitreous

has contracted. This is normal. In most cases, there are no adverse effects.

Some patients may experience a small increase in floaters, which are little

" cobwebs " or specks that seem to float about in your field of vision.

However, if the vitreous is firmly attached to the retina when it pulls

away, it can tear the retina and create a macular hole. Also, once the

vitreous has pulled away from the surface of the retina, some of the fibers

can remain on the retinal surface and can contract. This increases tension

on the retina and can lead to a macular hole. In either case, the fluid that

has replaced the shrunken vitreous can then seep through the hole onto the

macula, blurring and distorting central vision.

Macular holes can also occur from eye disorders, such as high myopia

(nearsightedness), macular pucker, and retinal detachment; eye disease, such

diabetic retinopathy and Best's disease; and injury to the eye.

Macular holes often begin gradually. In the early stage of a macular hole,

people may notice a slight distortion or blurriness in their straight-ahead

vision. Straight lines or objects can begin to look bent or wavy. Reading

and performing other routine tasks with the affected eye become difficult.

The size of the hole and its location on the retina determine how much it

will affect a person's vision. When a Stage III macular hole develops, most

central and detailed vision can be lost. If left untreated, a macular hole

can lead to a detached retina, a sight-threatening condition that should

receive immediate medical attention.

Although some macular holes can seal themselves and require no treatment,

surgery is necessary in many cases to help improve vision. In this surgical

procedure--called a vitrectomy--the vitreous gel is removed to prevent it

from pulling on the retina and replaced with a bubble containing a mixture

of air and gas. The bubble acts as an internal, temporary bandage that holds

the edge of the macular hole in place as it heals. Surgery is performed

under local anesthesia and often on an out-patient basis.

Following surgery, patients must remain in a face-down position, normally

for a day or two but sometimes for as long as two-to-three weeks. This

position allows the bubble to press against the macula and be gradually

reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the

vitreous cavity refills with natural eye fluids.

Maintaining a face-down position is crucial to the success of the surgery.

Because this position can be difficult for many people, it is important to

discuss this with your doctor before surgery.

The most common risk following macular hole surgery is an increase in the

rate of cataract development. In most patients, a cataract can progress

rapidly, and often becomes severe enough to require removal. Other less

common complications include infection and retinal detachment either during

surgery or afterward, both of which can be immediately treated.

For a few months after surgery, patients are not permitted to travel by air.

Changes in air pressure may cause the bubble in the eye to expand,

increasing pressure inside the eye.

The following organization may be able to provide additional information on

macular holes:

American Academy of Ophthalmology

P.O. Box 7424

San Francisco, CA 94120-7424