On occasion a small hole can spontaneously occur in the very center of the retina. This is called a macular hole. Because it affects the very center of the retina (termed the macula), it can cause distortion and a blank spot in the center of your vision. Once the macular hole reaches a certain point, it is unlikely to improve on its own.
Surgery can be performed to close the macular hole. The procedure is called vitrectomy. During this surgery the gel that fills the eye (called vitreous) is removed and replaced with saline (salt water). A small membrane is often removed from the retinal surface in the area of the hole to encourage the hole to close. Near the end of the surgery a gas bubble is placed in the eye. After surgery, the bubble gently presses on the hole to encourage it to close. In order to get the bubble into the correct position over the macular hole the patient often needs to sit or lay face down for part of the day for up to a week. The gas bubble slowly absorbs into the body over a couple weeks. Your ability to travel by airplane or to higher altitude will be limited during the period of time that the bubble is in your eye.
Once the macular hole is closed, there is often (but not always) an improvement in the vision, including better ability to read and improved distortion and blank spot in the central vision. When vision does improve, it can take several months.
Occasionally a small film of tissue, like cellophane, grows on the center of the retina. This condition is called an epiretinal membrane (ERM). The ERM can contract and distort the retina leading to blurring and distortion of the vision. ERMs can be very subtle and may not significantly affect the vision for long periods of time. Other times they can progress more rapidly and cause bothersome visual symptoms.
When ERMs are affecting the vision, surgery can be performed to remove the membrane. The procedure is called vitrectomy. During this surgery the gel that fills the eye (called vitreous) is removed and replaced with saline (salt water). The ERM is then removed from the retinal surface with very fine instruments placed into the eye. Afterwards, the vision often (but not always) improves, with improved central vision and reduction of distortion.
Visit the American Academy of Opthalmology’s webpage on Macular Hole.