A macular hole is a condition that affects the very central portion of the retina.  A macular hole may occur for a number of reasons including eye injuries, inflammation inside the eye and most commonly, the normal aging process. As we age, the vitreous gel in the back of our eye becomes more liquefied and often results in a Vitreous Detachment with associated floaters.  Sometimes, when the Vitreous “pulls’ it can actually form a macular hole.

Macular holes often begin slowly but usually will affect central vision depending on the severity.  They can occur as partial holes only affect part of the macular layers, causing wavy, distorted, blurred vision or they can occur as full thickness holes causing a complete loss of central vision.

Signs and Symptoms of Macular Holes

The severity of the symptoms of Macular Holes depends on whether the hole is partial thickness or full thickness, but in general may include the following:

• Blurred Central Vision
• Distorted, "Wavy" Vision
• Difficulty reading or seeing fine detail even with glasses
• Grayish Area in Central Vision
• Central Blind Spot or “Dark Spot”

Diagnosis and Treatment of Macular Holes

Macular Holes are easily detected through visual acuity testing in conjunction with an Amsler Grid Test, a dilated pupil examination of the macula with an Ophthalmoscope and Slit Lamp High Magnification Fundus Lens, Optical Coherence Tomography (OCT) and sometimes an Fluorescein Angiogram (FA) or other specialized photographs.

Some macular holes seal by themselves and do not require treatment.  In many cases however, surgery called Vitrectomy is necessary to close the hole and restore useful vision.  During Vitrectomy, the retinal surgeon will gently remove the vitreous gel in order to eliminate any traction on the Macula. A gas bubble is then injected into the eye to place gentle pressure on the Macula and help the hole to seal.  In many cases, patients enjoy functional vision after the bubble has been absorbed and the eye has healed.

Our retina specialists at Retina Group of Washington examine and treat patients with an epiretinal membrane, also referred to as a macular pucker or cellophane maculopathy. This retinal condition describes a cellophane-like membrane forming over the macula, or the central part of the retina.

It is typically a slow-progressing problem that can affect the central vision by causing blur or distortion.  As it progresses, the membrane may cause traction and lead to swelling of the macula.

Epiretinal membranes (ERMs) are more often seen in people over 70 years of age. Its exact cause is not completely understood, and the majority of ERMs have no associated ocular abnormality. Epiretinal membranes can be associated with other eye problems such as Diabetic Retinopathy, Posterior Vitreous Detachment, Macular Hole, and Retinal Detachment.

Signs and Symptoms of Epiretinal membranes

The signs and symptoms of Epiretinal membranes may include:

• Blurred Vision
• Double Vision in the affected eye
• Distorted Vision – straight lines appear bent or wavy

Diagnosis and Treatment of Epiretinal membranes

Epiretinal membranes are diagnosed with a dilated fundus examination and Optical Coherence Tomography (OCT).  If there is a significant effect on vision, a surgical procedure to “peel” the epiretinal membrane may be considered. If there is no or minimal effect on vision, observation is usually recommended.

Central Serous Chorioretinopathy is a retinal disorder which typically affects young to middle-aged patients, more often men.  It is characterized by a serous detachment of the retina, or an accumulation of serous fluid underneath the retina, usually in the central macular area.  Central Serous Chorioretinopathy is usually self-limiting, and most patients will have spontaneous recovery within a few months without significant visual loss. Some patients may develop chronic or recurrent disease that can lead to visual loss. Up to 50% of patients with Central Serous Chorioretinopathy can develop a recurrence which can happen at any time, but often within the first year after the first episode.

Symptoms of Central Serous Chorioretinopathy

Many patients first notice a minor blurring of vision, followed by varying degrees of “metamorphopsia” or distorted vision, “micropsia” or the perception that objects are smaller than they actually are, “chromatopsia” or objects looking unusually colored, or a shift of prescription toward farsightedness or hyperopia.  Visual acuity may range from 20/20 to 20/200 or worse.

Diagnosis and Treatment of Central Serous Chorioretinopathy

Central Serous Chorioretinopathy is diagnosed with a dilated fundus examination along with Optical Coherence Tomography (OCT), Fluorescein Angiography (FA), and possibly Indocyanine Green Angiography (ICG). Although most cases resolve without treatment, laser photocoagulation or photodynamic therapy may be considered in chronic or recurrent cases.