Macular Hole

In very rare instances, trauma or other conditions lead to the development of a macular hole. In the vast majority of cases, however, macular holes develop spontaneously. As a result, from traditional thinking there is no known way to prevent their development through any nutritional or chemical means, nor is there any way to know who is at risk for developing a hole prior to its appearance in one or both eyes.

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids.

Following surgery, patients must usually keep their faces down for two or three weeks. This position allows the bubble to press against the macula and seal the hole. At the end of the 2-3 week period of strict face-down positioning, the patient is then permitted to resume a more normal upright posture. The air bubble itself, however, may take anywhere from 6-8 weeks following surgery to completely disappear. The air bubble is gradually resorbed by the body, and the vitreous cavity is then filled with liquid produced by cells in the front of the eye.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment either during surgery or afterward.

Typically, for macular holes less than six months in duration, a vision improvement of approximately three lines on the eye chart (or 50% improvement) can be achieved. Obviously, this is an "average" visual improvement. Vision recovery varies on a patient-by-patient basis, and each patient must be evaluated on an individual basis and discuss with their physician the expectations for visual recovery. Some patients achieve only a small amount of vision recovery, while others achieve a more significant improvement.

Since we consider most eye conditions to be a reflection of the health of the whole body, lifestyle choices and diet can play a major factor in getting and maintaining good vision. Below are some recommendations:

• Reduce or eliminate drinking caffeine and sodas
• Avoid aspartame (labeled diet foods)
• Avoid man made fats (corn oil and safflower oil, trans fats and hydrogenated vegetable oils including canola oil, and especially margarines). Eating greater amounts of saturated fat and cholesterol appear to increase the risk of retinal problems
• Eliminate deep fat fried foods
• Avoid monosodium glutanate (MSG) used as a flavor enhancer which is a potential retinal toxin (Inv Oph 1996; 37: 1618-24), and fat blockers like Olestra which impair the absorption of carotenoids (Argus, August 1996;19:18:July 1996;19:22).
• Limit your alcohol consumption to 1 glass of red wine at night. Alcohol interferes with liver functions, reducing protective glutathione levels (Alcohol 1993;10;469-75).
• Eliminate smoking. Smoking among other things produces cyanide, a retinal toxin.
• Supplement your diet with a good multivitamin such as Dr. Grossman's Whole Food Multivitamin and/or a good green drink such as Renewal Greens.
• Limit the amount of medications (both prescription and non-prescription as much as possible. Make sure to work closely with your doctor.
• Exercise daily - do at least 20 minutes of aerobic exercise daily. Walking and swimming are two excellent forms of exercise.
• Manage your emotional health Fear (fear of failure, responsibility, of being alone, of death, etc.) is at the root of many of life's problems, and is a major factor in many diseases. Take up the practice of meditation, yoga, tai chi, walks in the woods or prayer on a daily basis.