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Kelly  NEWendel  RT Vitreous surgery for idiopathic macular holes: results of a pilot study.  Arch Ophthalmol. 1991;109654- 659Google ScholarCrossref
Poliner  LSTornambe  PE Retinal pigment epitheliopathy after macular hole surgery.  Ophthalmology. 1992;991671- 1677Google ScholarCrossref
Glaser  BMMichels  RGKuppermann  BDSjaarda  RNPena  RA Transforming growth factor-β 2 for the treatment of full-thickness macular holes: a prospective randomized study.  Ophthalmology. 1992;991162- 1172Google ScholarCrossref
Liggett  PESkolik  SAHorio  BSaito  YAlfaro  DVMieler  W Human autologous serum for the treatment of full-thickness macular holes.  Ophthalmology. 1995;1021071- 1076Google ScholarCrossref
Maeno  THattori  TNinomiya  Y  et al.  Visual functional changes in idiopathic macular holes treated by vitrectomy.  Nippon Ganka Gakkai Zasshi. 1996;10040- 45Google Scholar
Liesenhoff  OMessmer  EMPulur  AKampik  A Surgical management of complete macular foramina.  Ophthalmologe. 1996;93655- 659Google ScholarCrossref
Matsumura  M Impressions: a patient's view [letter].  Retina. 1998;18489Google ScholarCrossref
Sjaarda  RNFrank  DAGlaser  BMThompson  JTMurphy  RP Resolution of an absolute scotoma and improvement of relative scotomata after successful macular hole surgery.  Am J Ophthalmol. 1993;116129- 139Google Scholar
Acosta  FLashkari  KRaynaud  XJalkh  AEVan de Velde  FChedid  N Characterization of functional changes in macular holes and cysts.  Ophthalmology. 1991;981820- 1823Google ScholarCrossref
Tsujikawa  MOhji  MFujikado  T  et al.  Differentiating full thickness macular holes from impending macular holes and macular pseudoholes.  Br J Ophthalmol. 1997;81117- 122Google ScholarCrossref
Amsler  M Quantitative and qualitative vision.  Trans Ophthalmol Soc U K. 1949;69397- 410Google Scholar
Amsler  M Earliest symptoms of disease of the macula.  Br J Ophthalmol. 1953;37521- 537Google ScholarCrossref
Walsh  ARMagargal  LMWright  FDonoso  LA The early natural history of subfoveal neovascular membranes in eyes with age-related macular degeneration.  Ann Ophthalmol. 1989;21348- 350Google Scholar
Johnson  RNGass  JDM Idiopathic macular holes: observations, stages of formation, and implication for surgical intervention.  Ophthalmology. 1988;95917- 924Google ScholarCrossref
Gass  JDM Idiopathic senile macular hole: its early stages and pathogenesis.  Arch Ophthalmol. 1988;106629- 639Google ScholarCrossref
Gass  JDM Reappraisal of biomicroscopic classification of stages of development of a macular hole.  Am J Ophthalmol. 1995;119752- 759Google Scholar
Smith  RGHardmanlea  SJGalloway  NR Visual performance in idiopathic macular holes.  Eye. 1990;4190- 194Google ScholarCrossref
Schuchard  RA Validity and interpretation of Amsler grid reports.  Arch Ophthalmol. 1993;111776- 780Google ScholarCrossref
Jensen  OMLarsen  M Objective assessment of photoreceptor displacement and metamorphopsia.  Arch Ophthalmol. 1998;1161303- 1306Google ScholarCrossref
Watzke  RCAllen  L Subjective slit beam sign for macular diseases.  Am J Ophthalmol. 1969;68449- 453Google Scholar
Martinez  JSmiddy  WEKim  JGass  JDM Differentiating macular holes from macular pseudoholes.  Am J Ophthalmol. 1994;117762- 767Google Scholar
Smiddy  WEGass  JDM Masquerades of macular holes.  Ophthalmic Surg Lasers. 1995;2616- 24Google Scholar
Clinical Sciences
January 2000

The Visual Performance and Metamorphopsia of Patients With Macular Holes

Author Affiliations

From the Departments of Ophthalmology, Osaka University Medical School, Osaka (Drs Saito, Hirata, Hayashi, Fujikado, Ohji, and Tano), and Hyogo Prefectural Nishinomiya Hospital, Nishinomiya (Dr Saito), Japan.

Arch Ophthalmol. 2000;118(1):41-46. doi:10.1001/archopht.118.1.41

Background  Most patients attain better visual acuity with the elimination of metamorphopsia after successful closure of a macular hole (MH) by vitrectomy.

Objective  To determine the presurgical visual function of eyes with an MH.

Methods  We examined 54 eyes of 51 patients with an idiopathic MH using the Amsler chart. We evaluated the types of subjective metamorphopsia and compared them with the clinical factors associated with MHs. In a prospective study, we performed a montage test on a separate group of 16 patients with unilateral idiopathic MHs. The patients were asked to choose, while viewing with their better eye, the computer-modified picture that best matched the unmodified image seen by the eye with the MH.

Results  From the results of the Amsler chart test, we divided the subjective changes into 2 types of metamorphopsia; of the 54 eyes, pincushion distortion (bowed toward the center) was found in 33 (61%), and unpatterned distortion (no specific pattern) was found in 21 (39%). Pincushion distortion was significantly associated with an MH of shorter duration (≤6 months) (P = .03) and an early stage (stage 2) of MH formation (P = .02). A scotoma was hard to detect, and patients had difficulty describing their scotomata and distortions. In the montage test, patients with early MHs chose portraits modified with a pincushion type of distortion.

Conclusions  We found concentric pincushion metamorphopsia without subjective scotomata, which we suggest arises from an eccentric displacement of the photoreceptors. This accounts for the main characteristic of the visual performance of patients with idiopathic MHs.