Macular hole is a condition more common in people over 60 and can significantly affect reading, driving and the ability to see details. The exact cause is often linked to aging, but trauma and high myopia can also be risk factors. Treatment may include surgeries such as vitrectomy, which can help improve vision. The reader who writes, however, despite the surgery cannot see well and would like to know if there could be improvements over time.
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He replies Francesco OddoneHead of the Glaucoma Operational Unit of the IRCCS Bietti Foundation at the British Hospital in Rome.
Request. About a year ago I had macular hole surgery in both eyes. I had the first operation on my left eye which was worse than the right, but almost a year later I still can’t see well. Then I had the surgery on the other eye too. It is not yet possible to define an ophthalmological grade to understand if I see better with glasses, but I have no results and even with the other eye I cannot focus, I see distorted, I cannot read well and I cannot renew my driving license as for the visit, I can’t see the letters well and I can’t distinguish the people from not far away. I would like to know if in his opinion I will be able to improve my situation over time and what you recommend me to do, thank you.
Answer. The macular hole is a pathology that affects the central part of the retina called the macula and in particular the central part of the macula called the fovea. During the process of formation of the macular hole the retina at this point becomes increasingly thinner until it forms a real hole which can become full thickness. When this happens, the outer layers of the retina are irreversibly damaged, precisely where the photoreceptors reside, the specialized cells responsible for the reception and transduction of the visual signal. In these cases the visual damage becomes serious. Surgical therapy for the macular hole consists in freeing the retina from the tangential tractions that have caused the thinning and formation of the hole itself with the aim of bringing the edges of the hole closer together. Certainly after surgery the retinal tissues need time to recover a new architecture and functionality and visual recovery is in any case conditioned by the severity of the damage to the external retinal layers and photoreceptors which can vary from case to case.
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