What it is
In short: these are three different problems at the macula, the centre of the retina that you use for reading and recognising faces. They can cause similar symptoms, such as blurred or distorted central vision. A scan shows which one you have. Some need only regular checks, while others are treated with surgery.
The retina is the layer at the back of the eye that senses light. These three conditions affect the macula in different ways, so an examination and a scan are needed to tell them apart.
Macular hole
A macular hole is a small opening in the centre of the retina. It can develop as the vitreous, the clear gel inside the eye, pulls away from the retina with age.
Epiretinal membrane
An epiretinal membrane is a thin layer of tissue on the surface of the retina. As it tightens, it can wrinkle the macula. It is sometimes called a macular pucker.
Vitreomacular traction (VMT)
In vitreomacular traction, the gel comes away from most of the retina but stays stuck to the macula. It pulls on the centre of the retina and distorts it. Some of these attachments let go on their own. Others stay, and some are linked with a macular hole.
These are separate conditions, not three stages that everyone goes through.
Symptoms
You may notice:
- blurred central vision
- straight lines looking bent
- difficulty reading small print
- objects looking a different size in each eye
- with a macular hole, a missing or dark patch in the centre of your vision
An epiretinal membrane is sometimes found during a routine check, when it is causing few problems. Symptoms can come on slowly, and your other eye may make up for them. Tell Dr Chin about any distortion, not just blur. The letter chart does not show every difficulty you have in daily life.
When it is urgent
Any new change in your central vision should be checked promptly, because several conditions can cause it. Do not assume new distortion is just an existing membrane getting worse.
Get your eye checked the same day for sudden loss of sight, a shower of floaters, flashes or a curtain across your vision. These can be signs of other retinal problems.
Call the clinic at +65 6694 0400. Outside clinic hours, call the 24-hour answering service at +65 6535 8833, or go to a hospital A&E with eye services. After surgery, call straight away if pain increases or your vision gets worse. Do not wait for your next planned appointment.
What the assessment involves
Your vision is checked in each eye, and Dr Chin examines the retina, usually after drops to widen your pupils. The drops take 20 to 30 minutes to work and blur your sight for a few hours. Allow about 90 minutes to two hours for the visit, and arrange for someone to drive you home.
An OCT scan is the key test for these conditions. It uses light to take detailed cross-section pictures of the retina, showing its layers, any membrane and where the gel is still attached.
The scan can show the size and shape of a macular hole, or how much the retina is being pulled. Comparing scans over time shows whether things are stable or changing. Other tests may be used if Dr Chin suspects another retinal problem.
Dr Chin will also ask how long you have had symptoms, and how they affect tasks such as reading or sewing. The scan alone does not decide the plan. Your symptoms, your vision, any changes over time and the health of the rest of the eye all count.
Treatment options
Regular checks
Regular checks may be enough for an epiretinal membrane with few symptoms, or for VMT that does not need treatment. These usually include vision checks and OCT scans. You will be told when to come back and which changes to report.
Surgery for an epiretinal membrane
If a membrane affects your daily life or is getting worse, an operation called vitrectomy with membrane peeling may be suggested. Dr Chin removes the vitreous gel to reach the surface of the retina, then lifts the membrane away. Eye drops cannot remove an epiretinal membrane.
Surgery for a macular hole
Surgery for a macular hole usually involves a vitrectomy and placing a gas bubble in the eye. The bubble supports the macula while it heals. Some small holes can be watched instead, depending on their features.
Surgery for VMT
If VMT does not settle, a vitrectomy can release the pull on the retina. Whether it suits you depends on how much pulling the scan shows and how much it affects your vision. Choosing between waiting and surgery means weighing how much the problem affects you against the effort and risks of treatment.
Most retinal surgery is day surgery under local anaesthesia, and general anaesthesia can be used where needed.
Risks
Surgery has risks, including:
- cataract
- retinal detachment
- infection
- bleeding
- changes in eye pressure
A macular hole may also stay open, or open again.
Recovery and follow-up
After surgery, use your eye drops and follow the instructions on protecting your eye and on activity. Follow-up visits check healing and the macula, often with OCT scans. Vision and distortion can keep changing for a long time. How the retina looks on the scan does not on its own decide how well you will see.
If a gas bubble is used
- You may need to keep your head in a particular position. Tell Dr Chin before surgery about any neck, back or mobility problems, so the plan can allow for them.
- Your vision will be blurred while the gas is in the eye.
- Do not fly until Dr Chin confirms the gas has gone.
- Tell any anaesthetist that you have gas in your eye.
Follow the specific instructions you are given for your operation.