A macular hole is a small opening in the macula. It can be the result of a tear or from holes that develop as a person ages. Macular holes normally do not start appearing in individuals until they reach the age of 60. Hereditary issues, obesity, diabetes, and cardiovascular disease can cause macular degeneration to begin at a much earlier age. The macula is the area of the retina that is responsible for the primary field of vision. This central vision is what a person uses when they read, drive, do finely detailed work, or look at items close up. Macular holes can cause distorted and blurred vision but rarely cause pain or discomfort. It also has little to no effect on a person's peripheral vision. Over time holes that form due to aging can increase in both number and size.
The macula is the central portion of the retina that lies flat against the rear of the eyeball. A macula pucker occurs when the macula begins to draw or pull away from the back of the eye because of aging or other forms of macular deterioration. In some cases, the pucker can form behind the retina. When it forms on the surface, it can cause the back of the eye to contract and become warped. This can cause swelling and wrinkles that distort a person's vision, making it extremely difficult to read, write, or perform small tasks like threading a needle or finding a small object. In cases, where puckers are very severe, blind spots can form in the person's primary field of vision.
In the majority of cases, macular holes and puckers offer few to no symptoms, except for distorted or blurred vision. Small holes and puckers may not cause sufficient problems to cause a doctor to create a full treatment plan. When a person's vision reaches the point they cannot see to read or perform finely detailed work, doctor's can perform a vitrectomy. During this type of procedure, the vitreous fluid that fills the eye is removed. Vitreous fluid is responsible for maintaining the eye's overall shape. It's also partially to blame for the macula pulling away from the retina. By removing the fluid and replacing it with a small bubble of air, the doctor can help to eliminate the risk or further deterioration of puckers and holes as they form.