Retinal Damage: A Hole in the Macula

Symptoms   Causes   Conventional treatment   Vitamins & supplements   Tips
Photoreceptors   Connective   Hole / Wrinkle in the macula   Sugar balance   Vitamin A

One type of impairment of retinal connective tissue is when a small hole develops in the macula. This impairment takes place where the vitreous adheres to the retina at the macula.

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As we age, especially after 50, the vitreous humor which is the gel in the eye, contracts and pulls away from the surface of the retina. This is generally a mild separation without noticeable negative effect. More floaters might result but without significant visual damage.

macular hole

However, sometimes where the vitreous connective tissue is very firmly attached to the retina surface it can actually pull on the retina eventually forming a small hole in the macula. In addition, with aging the vitreous fluid is less gel-like and more liquid. In that condition it can more easily seep through such a small hole causing a defect or dark spot in central vision which manifests as loss of or distortion of central vision, as well as cause additional pulling on the retina.


Symptoms vary depending on whether the hole is small or extends the full thickness of the macula.

  • Distorted or wavy vision
  • Foggy central vision
  • Difficulty in close work tasks like reading
  • Blind spot or gray area in central vision


Very rarely injury to the eye can lead to this condition. Usually, however, these holes apparently develop spontaneously leaving little known method of preventing their development. It is unknown who is at risk.

Conventional Treatment

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. The air bubble itself, however, may take anywhere from 6-8 weeks following surgery to be gradually reabsorbed 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.

Vitrectomy for newly formed (6 months or less) macular holes can result, on average, in about 3 lines on the eye chart improvement. Recovery of vision varies. Some patients achieve only a small amount of vision recovery, while others achieve a more significant improvement.

Self Help

Although surgery is considered the only treatment, with good nutrition for our vision we may prevent vision problems such as a macular hole. About 50% of foveal detachment macular holes can heal by themselves. Since we consider many eye diseases to reflect the health of the whole body, lifestyle choices and diet can play an important role supporting this healing.

Research suggests that a number of nutrients including but not limited to zeaxanthin, lutein, vinpocetine, l-lysine, fish oil, and specific vitamins and enzymes may help preserve vision. Some research suggests that daily use of Microcurrent Stimulation (MCS) may help strengthen vision health as well.

Symptoms   Causes   Conventional treatment   Vitamins & supplements   Tips