Macular hole patients will go home the same-day, but since there is a gas bubble inside of the eye, patients are frequently required to spend a few days in face-down positioning. When we mention face-down positioning, we encourage looking towards to floor as much as possible. We recognize that this can be difficult, so it is something we discuss with you during consultation. Since the macula is in the back of the eye, when you are face-down, the gas bubble is pressing directly against the macula (at the back of the eye), resealing the hole and returning the retinal tissue to its intended position. While your hole may still close without face-down positioning, the risk for experiencing a persistent macular hole increases.
The gas bubble will be present in your eye for anywhere from 2-8 weeks and during this time your vision will be limited. As the gas bubble decreases in size during this time, your vision will gradually return. The macular hole is typically found to be completely closed and your vision returned to normal.
A side effect of this surgery is that it accelerates the formation of a cataract in the months after your procedure. Thus, once your macular hole is completely repaired, your vision may start to blur months later, in which case you may seek out cataract surgery. Additionally, when a gas bubble is present, you are unable to travel by plane or perform other activities where a change in altitude occurs (scuba diving, hiking a mountain, etc.).
Option #2: Pneumatic Vitreolysis
This option is an in-office, less-invasive procedure to treat a macular hole. While surgery is the most successful treatment to repair a macular hole, there are some instances when your retina specialist may recommend a pneumatic vitreolysis. During this procedure, a gas bubble will be injected into your eye. This gas will push against the vitreous humor and relieve the vitreous traction on the macula which is causing the macular hole. This release is sometimes enough to allow the hole to close, thus preventing the need for vitrectomy surgery.
Option #3: Topical Therapy
In a very few select cases, a macular hole can be small enough to close with eye drops. This is the least invasive option. However, drops are effective in only a small percentage of cases.
Will my health insurance cover this surgery?
Dr. Shane is in network with most major insurances, so surgery is typically covered subject to your copayments and deductibles.
I don’t know if I can do face-down positioning after surgery – what should I do?
The positioning requirements after a surgery requiring a gas injection in the eye are strenuous. Even if you don’t position at all, there is still a good chance that your macular hole will close. However, the chances of successful surgery are increased with face-down positioning. There are some options to make the positioning requirements easier, such as in-home equipment designed to make a face-down position more comfortable and convenient. This equipment is often covered by insurance, too! Dr. Shane will discuss all of the risks, benefits, and alternatives to treatment with you during your consultation and answer any questions you may have!
What Should I Do Next?
If you are experiencing any distortion or a new blind spot in your central vision (in one or both eyes), it is important to schedule a prompt dilated eye examination with a qualified ophthalmologist. Your physician will dilate your eyes to be able to properly evaluate your retina (where a macular hole occurs), check your intraocular eye pressure, and obtain specialized imaging of your eyes. Dr. Shane specializes in macular hole repairs, having performed countless operations to repair them and restore vision to her patients. Please do not delay your evaluation – contact our office today!