Macular Degeneration — Macular Hole

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Macular Degeneration or Macular Hole? What’s the Difference?

Macular Degeneration or Macular Hole? What’s the Difference? 0

Macular Degeneration or Macular Hole? What’s the Difference?

Many people each year go blind or have severely impaired vision as a result of macular degeneration. Macular degeneration is a progressive eye disease, mostly associated with age, that affects millions of Americans each year. In fact, it’s the leading cause of vision loss for senior citizens in America.

What is Macular Degeneration?

Macular degeneration occurs in the macula, the region at the center of the eye’s retina. It’s the part of the eye that responds most readily to light and allows the eye to focus precisely on small regions, such as the print on a book or the pixels on a phone screen. The pigmentary cells in the macula deteriorate and break apart, leading to the buildup of a substance called drusen in the eye which impedes clear vision. Because the macula is closely associated with precise focus, you may still be able to see quite well on the periphery even as the macula breaks down.

Macular degeneration is simply the progressive breakdown of the macula over time, stemming from this “clogging” effect as drusen builds up within the eye. In contrast, macular hole is a more distinct problem. As the name implies, it is literally a hole that develops in the macula. It can begin as the result of trauma or disease, but like macular degeneration — it generally begins simply as the result of aging.

An explanation of Macular Holes

Unlike macular degeneration, which starts in the macula, a macular hole actually begins in the vitreous body, which is the “jelly” that fills your eye. As you age, the vitreous body naturally contracts over time, stressing the fibers that connect it to the retina. In addition, these miniscule fibers can break down, allowing the vitreous to move more than it should.  The combination of vitreous shrinkage and degradation of the connective fibers can actually pull the vitreous body far enough away from the macula to create a small tear in the macula itself. This tear typically develops first into a macular cyst and then, if left untreated, progresses to a macular hole.

A small fraction of macular holes will actually heal themselves; for the rest, treatment typically involves a surgery called vitrectomy. In this procedure, the vitreous body is actually severed from the eye and replaced with an artificial vitreous “bubble.” This bubble presses against the macula, sealing the macular hole and enabling it to heal. As the macula heals, the eye’s cavity will refill itself with fluid and the bubble will naturally be absorbed by the eye. This process will require the patient to lie face-down for anywhere from two days to three weeks. Yikes! As you can tell, this is an extensive procedure and will only be performed if vision loss is severe. Because this is a progressive problem that can lead to serious vision impairment or loss, it’s important to discuss any vision issues quickly with your doctor if you suspect you may be developing a macular hole.

Have you ever experienced a macular hole? What did you notice?


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Dr. Jenna Zigler, Eye Love

Dr. Jenna Zigler

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