Living with a macular hole

A macular hole is a tear or gap in the macula at the centre of the retina. A macular hole causes blurred or distorted vision because the macula is responsible for our central vision, which we rely on to see fine details and for driving and reading.  

If you’re living with a macular hole, your central vision will probably be affected. It can cause blurred and distorted vision in the affected eye and even progress to cause a blank spot but doesn’t affect peripheral vision.

Macular hole stages and types

Macular hole typically follows three stages:

• Foveal cyst (Stage 1) – untreated, about half of cases get worse.
• Small full-thickness macular hole (Stage 2) – untreated, about 90% of cases worsen.
• Large full-thickness macular hole (Stage 3 and 4) – most cases at this stage will get worse if untreated.

The first symptom of a macular hole is usually a change in vision. You might notice your vision becomes more blurred or distorted, and you have trouble seeing fine details when reading or watching TV. You might also notice that straight lines start to look wavy or bumpy.

As macular hole progresses, it can create a missing patch or black spot in your central vision. However, because the macula is responsible for central vision, a macular hole doesn't affect your peripheral vision (also known as side vision), and the condition isn't painful.

If a full-thickness (stage 2) macular hole develops, you can lose most of your central vision so it's important to see an optician if you notice any of these symptoms.

At Guide Dogs, we have a wide range of services, both with and without guide dogs, and a team of experts who can work with you to understand your needs and agree on a plan that’s right for you.

The ways we could help you:

• Habilitation or rehabilitation of important life skills
• Our guide dog service
• Our Vision Rehabilitation Specialists can make recommendations best suited to you and your needs
• Tips and advice to help you make the most of your remaining vision
• Resources and support on how technology can improve your independence

Working with a macular hole

Being diagnosed with a macular hole doesn't necessarily mean you can't work. The effect on your central vision depends on the stage of the condition and the size of the hole.

If your sight is affected, it may be a good idea to tell your employer. There could be things they can do to help you at work, and it's their responsibility to make reasonable adjustments. We have lots of ideas for coping with changes to your central vision.

It’s also a good idea to tell work if you’re going to have surgery so that you can plan ahead together. Everyone having macular hole surgery will need some time off to recover. The length of time off you need will depend on the type of work you do. For example, if your job involves driving, you may need more time off. You can discuss returning to work with your ophthalmologist at a check-up appointment after the surgery.

Driving with a macular hole

Having a macular hole can affect your central vision, causing symptoms such as blurred or distorted vision and straight lines or objects appearing wavy or crooked. At an advanced stage, a macular hole can cause a black patch at the centre of your vision. Because of this, it may affect your ability to drive safely. The DVLA has a minimum required standard of vision for driving. Speak to your ophthalmologist for advice, based on how the condition is affecting you. When recovering from surgery to repair a macular hole, you won't be able to drive. It's likely to be six to eight weeks before your eye recovers sufficiently.

Support for people living with a macular hole

Being diagnosed with a condition that affects your sight can be an upsetting time, and you might worry about how you'll cope with lasting changes to your vision. However, there's support available to help you adjust to any changes, and you may be reassured by hearing from others who've been there before you.

Support organisations

• Macular Society