Macular hole is a retinal disorder that appears deceptively simple: a neat, round defect in the center of the macula, usually occurring in elderly women and causing legal blindness; no treatment is apparently available. With more careful assessment, however, the issues are not so straightforward. A macular hole is a challenge for ophthalmologists to explain and to treat.
See also p 1088.
Macular holes, although sometimes bilateral, are rarely simultaneous in onset. This provides us with an opportunity to observe early lesions in fellow eyes, where the slightest visual disturbance is usually noticed and reported by the frightened patient.
Improved diagnostic acumen and increased sophistication about pathogenesis of retinal diseases have facilitated the development of a more detailed description of lesions that may be precursors of a macular hole. In 1988 Gass1 presented a description and classification of the various stages of macular hole formation and a hypothesis that
de Bustros S. Early Stages of Macular HolesTo Treat or Not to Treat. Arch Ophthalmol. 1990;108(8):1085-1086. doi:10.1001/archopht.1990.01070100041029