The macula is located in the center of the retina, which is the innermost layer of the eye, and it is the most critical area for visual function. Functions such as reading at close distance, identifying small print, distinguishing colors, and seeing faces clearly are possible thanks to the macula. The health of this region is vital for quality vision. However, in some cases, small tears or holes may form in the macular layer. This condition is called a “macular hole” and usually affects central vision.

Individuals with a macular hole see blurriness or a dark spot in the center of the objects they look at. Visual acuity decreases, and straight lines begin to appear wavy. In advanced stages, vision loss may occur to a degree that seriously restricts a person's daily life.

Op. Dr. Diclehan emphasizes that a macular hole is a disease that particularly occurs due to aging and can cause permanent vision loss if not diagnosed early.

Causes of Macular Hole

Age-Related Changes

The most common cause of a macular hole is aging. As the human eye ages, many of its structures undergo changes. The vitreous, which is the gel-like substance filling the eye, becomes more fluid with age and begins to separate from the retina. This process is normally physiological, but in some cases the vitreous remains tightly attached especially to the macular area. As the vitreous attempts to separate from the retina, it pulls on the macula, weakening the tissue and eventually leading to the development of a hole.

Effects of Trauma

A macular hole is not seen only in elderly individuals. It may also occur in young people as a result of eye trauma. Sports injuries, traffic accidents, or sudden pressure changes can disrupt the balance between the vitreous and the retina, causing tearing in the macula.

Myopia and Retinal Diseases

In people with high myopia, the eyeball is longer than normal. This structural difference thins the retinal layer and increases the risk of macular hole. In addition, diseases such as diabetic retinopathy, retinal vein occlusion, and retinal detachment may also predispose to the development of a macular hole.

After Eye Surgery

It has been observed that some patients may develop a macular hole after eye surgeries such as cataract or retinal surgery. Changes occurring in the vitreous structure and retina after surgery may contribute to this condition.

Op. Dr. Diclehan particularly states that the most important cause of a macular hole is aging, but trauma and myopia in young people should also not be ignored.

Symptoms of Macular Hole

Central Vision Loss

The most prominent symptom of a macular hole is impairment of central vision. Patients notice a blurry or dark spot right in the center of the objects they look at. This becomes quite disturbing when reading a book, watching television, or looking at someone’s face.

Wavy and Distorted Vision

Patients begin to see straight lines as curved, broken, or wavy. This is especially noticeable when looking at straight lines such as notebook lines or window frames.

Decreased Visual Acuity

As the macular hole progresses, visual acuity decreases. Initially, this may be perceived only as slight blurriness, but over time it can turn into significant vision loss.

Fading of Colors

The macular region contains a high concentration of cells responsible for color vision. Damage to this area leads to colors being perceived as duller and more faded.

Op. Dr. Diclehan emphasizes that distortion in central vision and wavy vision are the most typical signs of a macular hole and that people experiencing these symptoms should undergo an eye examination without delay.

Stages of Macular Hole
A macular hole is classified into different stages according to its development process, and the treatment approach may vary at each stage.

Stage 1 – Initial Phase
At this stage, a full-thickness hole has not yet formed. The vitreous is pulling on the macula, but only thinning and small structural changes are seen. Visual complaints are mild.

Stage 2 – Small Hole
A small hole has formed in the macular layer. Patients experience more noticeable impairment in central vision.

Stage 3 – Developed Hole
The diameter of the hole has increased. Visual acuity is significantly affected. Straight lines appear wavy, and reading becomes difficult.

Stage 4 – Advanced Macular Hole
The vitreous has completely separated, and a full-thickness hole is present in the macula. Vision loss is quite marked and may become permanent if not treated.

Op. Dr. Diclehan states that determining the stage of the macular hole is extremely important for treatment planning and that surgery yields more successful results especially in early-stage cases.

Diagnosis of Macular Hole
A macular hole is usually easily noticed during an eye examination, but advanced imaging techniques are used for a definite diagnosis.

Fundus Examination
During examination with an ophthalmoscope, a round defect is observed in the center of the retina. This is the main sign of a macular hole.

Optical Coherence Tomography (OCT)
The OCT device provides high-resolution cross-sectional images of the retinal layers. The size and depth of the macular hole and its effect on the retina are clearly evaluated.

Vision Tests
Using the Amsler grid test, it is evaluated whether straight lines are perceived as wavy. In addition, visual acuity is measured to determine the severity of the disease.

Op. Dr. Diclehan emphasizes that OCT is indispensable in the diagnosis of macular holes and that early diagnosis significantly increases treatment success.

Treatment of Macular Hole
Observation and Follow-up

If the macular hole is very small and in the early stage, the patient may be kept under regular follow-up. However, surgical treatment is required in most cases.

Vitrectomy Surgery
The most commonly used method in the treatment of a macular hole is vitrectomy surgery. In this procedure, the vitreous inside the eye is removed, the membrane over the hole is cleaned, and a special gas is injected into the eye. The gas bubble supports the macula and enables the hole to close.

Postoperative Process
Patients need to lie face-down for a certain period after surgery. This allows the gas bubble to apply pressure to the macula and accelerates healing. The healing process may vary between several weeks and several months.

Success Rates
Vitrectomy is highly successful in experienced hands. In the vast majority of patients, the macular hole closes and visual quality improves. However, it may not always be possible for vision to return completely to its previous level.

Op. Dr. Diclehan states that vitrectomy surgery is the most effective method in the treatment of a macular hole and that success rates are very high, especially when performed early.

What Is the Cost of Macular Hole Treatment?
The cost of macular hole treatment depends on many factors. The healthcare center where the surgery is performed, the technologies used, the surgeon’s experience, and the general condition of the eye are the main factors affecting the cost. In addition, the type of gas or silicone placed in the eye may also influence the cost. Therefore, it is not possible to state an exact figure.

Op. Dr. Diclehan emphasizes that when planning treatment, the priority should not be the cost but the preservation of visual health, and that choosing the correct method is far more important for the patient’s quality of life.

Macular Hole and Quality of Life
A macular hole seriously affects the daily life of patients. Reading books, using a computer, looking at a phone screen, or driving becomes difficult. The presence of a gap or distortion in central vision restricts independent living. This situation may also psychologically strain patients.

Op. Dr. Diclehan states that the quality of life of treated patients improves significantly, but patience and regular follow-up are essential. According to him, a macular hole is not only an eye disease but also a condition that affects social life.

Prevention of Macular Hole

It is not completely possible to prevent a macular hole, since it is mostly a result of the aging process. However, some precautions may reduce the risk.

Controlling diabetes and hypertension
Avoiding smoking and alcohol
Protecting the eyes from trauma
Having regular eye examinations
Eating a healthy diet rich in antioxidants

Op. Dr. Diclehan emphasizes that regular eye check-ups and a healthy lifestyle are very important in early detection of serious eye diseases such as macular hole.

A macular hole may look like a small opening in the center of the retina, but it creates serious effects on visual quality. If not detected early, it may cause permanent vision loss. The most effective treatment is vitrectomy surgery, and when performed at the right time, the success rate is quite high. Although the treatment cost varies from person to person, the main priority should be the protection of visual health. Op. Dr. Diclehan emphasizes that early diagnosis of macular hole is of vital importance; therefore, especially individuals over the age of 50 should have regular eye examinations.