Macular Hole is not uncommon over age 50 years. It is common in males and females but more common in females. It presents either with sudden central distortion or as an incidental finding at an optician visit. 

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The most common cause is interaction of the vitreous face with the macular surface. As we get older, the vitreous separates from the retinal surface and usually does so without any pulling on the retina or macula. In some persons, there is some pulling at the fovea which results in a macular hole. 

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Macular holes can be seen as being in stages depending on how much separation has occurred from the vitreous. Earlier stage 1 macular holes have a high chance of closing spontaenously so these should be observed at first. Stage 2 holes have a 40% chance of closing spontaneously so these can be observed for a few weeks. If they progress to stage 3, surgery is recommended as the chance of spontaneous closure is lower (10%). Studies have shown that surgery should be done within 3 months of onset of the macular hole to give the best visual outcome. The longer the hole is untreated, the larger it becomes and the lower the chance of successful closure and improvement in vision. 

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Surgery for macular holes is very successful (95%) and results in visual improvement at least 70% of the time. During surgery, vitrectomy is performed, followed by staining of the internal limiting mebrane (ILM) of the retina. The ILM is peeled and a gas bubble is placed in the vitreous cavity. 

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After surgery the patient may need to lie face down for 5-7 days to get the best closure of the macular hole.