An accurate and timely diagnosis of macular hole is essential to prevent permanent central vision loss.
Many people with macular holes experience blurry vision or central blind spots. These symptoms are similar to other eye diseases like macular degeneration. That’s why a full eye exam is needed to tell the difference.
Eye doctors use a mix of patient history, vision tests, and detailed scans to confirm the condition and its stage.
In the early stages, this condition can go unnoticed, especially if it affects just one eye. So, regular check-ups and early awareness are very important for a successful outcome.
Common Symptoms and Patient History
The diagnosis of macular hole often starts by listening to the patient. The doctor will ask about symptoms and past eye health. Common signs that raise concern include:
- Blurry or distorted central vision
- A dark spot in the middle of vision
- Trouble recognising faces or reading
- One eye being worse than the other
People over 60, those with severe nearsightedness, or anyone who recently had cataract surgery are more at risk. If you notice a slow change in central vision, the eye doctor will likely suggest further tests.
Vision Tests: Amsler Grid and Acuity Checks
During the exam, the doctor checks how well each eye can see. People with a macular hole usually have poor central vision in one eye, but side vision stays normal.
The Amsler grid is a quick test to spot problems in the macula. You focus on the center of a grid. If some lines look wavy or vanish, it may mean there’s a macular hole. This helps doctors find the exact part of the eye that is damaged.
Direct Eye Exam with a Slit Lamp
Next, the eye specialist looks closely at the retina using a slit-lamp microscope. This tool shows fine details at the back of the eye.
In early stages, the retina might look a bit uneven. In later stages, the doctor may notice:
- A clear round hole in the macula
- Raised edges around the hole
- Loss of yellow macular pigment
- Pulling away of the vitreous gel from the macula
These visible signs offer helpful clues and guide the next steps.
High-Detail Imaging with OCT
The most accurate way to confirm the diagnosis of macular hole is with Optical Coherence Tomography (OCT). This scan gives high-resolution, cross-section images of the retina without touching the eye.
With OCT, doctors can:
- See the hole’s size and depth
- Tell if it’s partial or full thickness
- Spot pulling from the vitreous or extra tissue
- Track healing after surgery
OCT also helps grade the stage of the hole:
- Stage I: Early signs with the center beginning to detach
- Stage II: Small hole that doesn’t go all the way through
- Stage III: Full hole with the gel still attached
- Stage IV: Full hole with the gel fully pulled away
This staging helps doctors decide when and how to treat the hole.
Extra Tools: Fundus Photography and More
Doctors also use fundus photography to take color pictures of the retina. These images help track changes over time. Though not as exact as OCT, it’s useful for spotting other problems like scar tissue. It also helps explain the condition to patients visually.
When Fluorescein Angiography Is Needed
Sometimes, the signs are unclear or mixed with other eye issues. In such cases, doctors may use fluorescein angiography.
This test involves a dye injection into your arm. As the dye travels through your eye’s blood vessels, a special camera takes pictures. Though it’s not routine for diagnosis of macular hole, it helps rule out conditions such as:
- Wet macular degeneration
- Fluid buildup under the retina (central serous chorioretinopathy)
- Swelling in the macula (macular oedema)
Differentiating from Other Eye Conditions
Not all central vision loss means a macular hole. That’s why proper diagnosis is key. Other possible causes include:
- Macular degeneration: May look similar but has yellow spots and retina thinning.
- Epiretinal membrane: Causes wrinkles in the retina but no central hole.
- Cystoid macular oedema: Builds up fluid in the retina, usually after surgery.
- Central serous retinopathy: Causes a bubble under the retina, often temporary.
Only the right diagnosis leads to the correct treatment. Macular holes often need surgery, while other issues may not.
When to Refer to a Specialist
Doctors may watch Stage I holes if vision is still good. But when a full-thickness hole shows up, referral to a retinal surgeon is urgent.
Waiting too long can lead to scar tissue and vision loss that surgery can’t fix. Eye doctors often repeat OCT scans over time. This helps spot changes early, especially in Stage I or II, where the hole might even close on its own — though this is rare.
Summary: Early Diagnosis of Macular Hole Saves Sight
The diagnosis of macular hole involves history-taking, vision tests, and detailed scanning, especially with OCT. Correct staging of the hole is vital for choosing the best treatment.
The sooner the problem is found, the better the chance of saving clear vision. People over 60 or with other eye conditions should have regular check-ups to catch issues early.
