The macula, located at the center of the retina, plays a vital role in providing sharp, central vision necessary for tasks like reading, driving, and perceiving fine details. However, when a hole forms in the macula, it can lead to central vision becoming distorted, darkened, or even lost over time if left untreated. In the United States, macular holes are relatively rare, with a prevalence of approximately 0.33% among individuals over the age of 55. The condition becomes more common as patients enter their 70s.
Statistics show that about 7.8 per 100,000 people are newly diagnosed with macular holes each year, after accounting for age and sex. 1 Research also reveals that 80% of these cases affect only one eye (unilateral), and women make up two-thirds of the diagnosed population.2
A macular hole is a small defect in the macula, the central part of the retina responsible for sharp, detailed vision. The eye contains a gel-like substance called the vitreous, which helps maintain the shape of the eye and sits between the retina and the iris. As we age, the vitreous begins to liquefy and may clump together, which can tug on the retina’s connective tissue. In most cases, this separation happens without causing significant issues, though it can occasionally lead to a vitreous or retinal tear or detachment.
During the early stages of vitreous changes, individuals may notice floaters or flashes of light, even if their vision remains unaffected. If these symptoms occur, it’s crucial to contact an eye doctor for a comprehensive evaluation. In some cases, where the vitreous remains firmly attached to the retina, the pulling can create a small hole in the macula. Over time, this defect may allow vitreous fluid to seep through, resulting in a dark spot or distortion in central vision. Patients may experience blurred or distorted vision, as well as a noticeable loss of clarity in their central field of view.
Trauma-Related Macular Hole
Trauma-related macular holes are believed to result from a concussive impact on the opposite side of the head. The force of the blow creates a shockwave that travels through the eye, causing the macula to rupture at its thinnest and most vulnerable point. This type of macular hole is distinct from those caused by aging or vitreous changes, as it is directly linked to physical trauma.3
Idiopathic-Related Macular Hole
Idiopathic macular holes occur when the vitreous, a gel-like substance inside the eye, begins to contract and pull on the retina. The vitreous is made up of millions of fine, intertwined fibers that are tightly connected to the retina. As the vitreous gel and its surrounding sac shrink, the pulling motion—especially at a tangent—can create a hole in the macula, typically at its thinnest point. This process can also lead to retinal and vitreous detachments, which are further exacerbated by the contracting vitreous. Idiopathic macular holes progress through four distinct stages, each impacting vision differently.4 Each stage has distinct visual characteristics that allow an eye doctor to identify the severity in an eye exam.
Signs and Symptoms
The severity of the symptoms is dependent upon whether the hole is partial or full-thickness. Signs and symptoms include:
- Distorted, wavy vision
- Blurred central vision
- Central blind spot or gray area
- Difficulty in detail tasks, such as reading
Other Related Conditions
Researchers have identified a strong connection between full-thickness macular holes and a high prevalence of lattice degeneration.5
Another related condition, macular puckers, can also result from the shrinking of the vitreous. Unlike macular holes, macular puckers often involve the retina repairing itself, but this repair process can leave a scar on the macula. While both conditions can cause blurred and distorted vision, the effects of macular puckers are generally less severe than those of macular holes. In most cases, treatment for macular puckers is unnecessary unless the vision distortion or loss becomes significant. Also referred to as epiretinal membrane (ERM) or cellophane maculopathy, macular puckers typically do not require intervention unless symptoms worsen.
Conventional Treatment
Surgery is often the recommended treatment for severe macular holes, with a procedure called vitrectomy being the most commonly used. During a vitrectomy, the vitreous gel is carefully removed to eliminate any pulling on the retina. It is then replaced with a gas bubble, which helps to seal the hole by pressing against the macula. After the surgery, patients are typically required to keep their faces in a downward position for about a week to ensure the bubble remains in the correct position for healing. Over the course of 6 to 8 weeks, the gas bubble is gradually reabsorbed by the body, and the vitreous cavity is naturally filled with fluid produced by cells in the front of the eye.
Vision recovery following surgery varies from patient to patient. While vitrectomy is generally effective, it does carry some risks. The most common complication is an increased likelihood of cataract development. Less frequent complications include infection and retinal detachment, which may occur during or after the procedure.
Complementary Approach
In some cases, when a macular hole is small, an eye doctor may opt to simply monitor it, as the body can occasionally heal the hole naturally over time. Supporting this natural healing process is possible through good nutrition and targeted supplements, which may also help reduce the risk of future macular holes.
For individuals prone to macular holes, such as nearsighted seniors, specific supplements can play a key role in maintaining a strong and healthy retina. Essential nutrients include lutein, zeaxanthin, meso-zeaxanthin, omega-3 fatty acids, gingko biloba, vitamin C, hyaluronic acid, and lysine. Additional beneficial nutrients to consider are bilberry, resveratrol, vitamin D3, astaxanthin, and a high-quality, whole food multivitamin. Incorporating these into a balanced diet can provide valuable support for retinal health and overall eye wellness.
Juicing
Incorporating daily juicing with organic produce can be a fantastic way to support overall health, especially when using a variety of fresh ingredients. Consider including combinations of ginger, leeks, garlic, parsley, cabbage, beets, carrots, spinach, apples, celery, grapes, lemon, raspberries, wheatgrass, and chlorophyll. Feel free to add your favorite fruits and vegetables, but be mindful of limiting high-sugar options like carrots, beets, and certain fruits to maintain a balanced nutritional profile.
For the best results, use room-temperature produce and avoid adding ice or cold liquids, as these can disrupt the stomach’s natural digestive processes. During cooler months, it’s a great idea to shift from juicing to nourishing vegetable soups or stews, which align better with seasonal needs and help maintain digestive health.
Recent Dr. Grossman Patient Testimonial Regarding Our Recommended Supplements
“I had my retina appointment and it went very well. The macular hole is now “lamellar hole”. The doctor ordered a second macula scan during the appointment, in a higher resolution, because he wasn’t seeing what he saw month ago. He explained on the scan that the hole now doesn’t go through all retina layers anymore. He said to go back in 2 months!”
Supplements
NMN Wonderfeel Capsul 60 vegcaps
Advanced Eye & Vision Support Formula (whole food) 60 vcaps
Dr. Grossman’s Meso Plus Retinal Support and Computer Eye Strain Formula with Astaxanthin 90 vcaps
Dr. Grossman’s Advanced Eye and Dr. G’s Whole Food Superfood Multi1 20 Vcap Combo – 2 months supply
Resveratrol (Trans) w/Quercetin 60 vegcaps
Dr. Grossman’s Bilberry/Ginkgo Combination 2oz (60ml)
Dr. Grossman’s Blood Vessel Control Formula 2oz
H2 Elite Molecular Hydrogen 30 tabs
Recommended Books
Natural Parkinson’s Support: Your Guide to Preventing and Managing Parkinson’s
- https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2603482#eoi160112r2 ↩
- Steel DH, Lotery AJ. Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond). 2013;27(suppl 1):S1-S21. ↩
- Ibid. Medscape. Macular Hole. ↩
- Johnson, R.N., Gass, J.R. (1988). Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Opthalmology, Jul 95(7):917-24. ↩
- Zhang, J., Li, Y., Zhao, X., Cai, Y., Yu, X., Lu, L. (2015). Relationship between full-thickness macular hole and retinal break/lattice degeneration. Eye Sci, 30(4):156-9. ↩