[Sportschosun reporter Jang Jong-ho] Mr. Hwang, a man in his 60s, recently experienced a sudden decline in vision. In particular, he found that one or two letters in the center of a page were difficult to see when reading, and that objects appeared distorted. Tests revealed that he had a macular hole, a condition in which a hole forms in the macula, which functions like the eye's film.
If one eye becomes noticeably blurry with age or objects appear distorted and bent, the condition should not be dismissed as simple presbyopia; a macular hole should be suspected. Symptoms may be mild at first, but as the disease progresses, patients can experience serious difficulties in everyday activities, such as recognizing faces, reading and driving.
The macula is the central part of the retina, the nerve tissue that lines the inside of the eye, and is responsible for central vision, which allows people to distinguish fine details. A macular hole develops when a small gap forms in the macula, nerves in the macular area are lost and the tissue becomes deformed, eventually leading to a hole across all layers of the macula.
A macular hole can easily be confused with macular degeneration, but the two conditions have different causes. Macular degeneration impairs vision as the macula ages and abnormal blood vessels develop. A macular hole, by contrast, occurs when the vitreous body, a gel-like tissue filling the inside of the eye, contracts with age and pulls on the macular tissue, eventually creating a hole. It affects about three in every 1,000 people in South Korea and is relatively common.
High myopia, uveitis, cystoid macular edema and trauma can also increase the risk of a macular hole. These conditions can weaken the macular tissue's ability to withstand external pulling forces or strengthen the force with which the vitreous body pulls on the macula.
There may be no noticeable symptoms in the early stages, and the condition is sometimes discovered by chance during a health checkup or a preoperative examination for cataract surgery. However, once a complete hole forms in the macula, decreased vision and various visual disturbances can occur.
Typically, the outline of a person's face may remain visible while the central features, such as the eyes, nose and mouth, appear blurred. When reading, only the letters in the center may be difficult to see. Straight lines, such as those on an apartment building's exterior wall or a crosswalk, may appear bent, while objects may look uneven or distorted.
The most important test for diagnosing a macular hole is optical coherence tomography (OCT). By imaging cross-sections of the retina, it can show whether the vitreous body is pulling on the macula, how much the macular tissue has been damaged, and the size and depth of the hole.
Not every macular hole requires surgery. If the vitreous body is pulling on the macula but a hole has not yet formed, if only some layers of the retina have split, or if the hole is very small, doctors may monitor the condition through regular examinations. In the early stages, the condition may also improve as the vitreous body naturally separates.
However, vitrectomy may be performed when a hole has formed across the entire macula and is expected to enlarge. The vitreous body pulling on the macula is safely separated from the retina and removed. If necessary, the internal limiting membrane on the retinal surface is also removed. When the hole is large, autologous serum or a similar substance may be used to promote closure.
After surgery, gas is injected into the eye to press the edges of the macular hole together. Because gas rises like an air bubble in water, patients must remain face down for about two to six weeks, before the gas is absorbed, so that it can properly press against the nerve tissue at the back of the eye where the macula is located. Patients who have difficulty maintaining a face-down position may receive silicone oil instead of gas. However, silicone oil is not absorbed naturally, so a subsequent operation is required to remove it.
Most patients experience improved vision after surgery, but they may not fully recover their preoperative vision because nerve damage has already occurred as the macular hole formed. The prognosis is relatively favorable when the hole is small and has developed recently. When the hole is large or longstanding, however, visual recovery may be limited.
Professor Kim Jin-ha of the Department of Ophthalmology at Soonchunhyang University Bucheon Hospital said, "If the central area of vision in one eye becomes difficult to see or straight lines appear bent, people should not simply attribute the symptoms to presbyopia but should undergo an ophthalmological examination." She added, "Because complete visual recovery is difficult once a macular hole progresses, it is important to monitor its progression regularly and receive treatment at the appropriate time."
Jang Jong-ho, reporter, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
