Macular Holes and Macular Hole Repair

Frequently Asked Questions

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Will I get at least partial benefit from the surgery if I can’t keep my head down?

This is - by far! - the most commonly asked question. The success of macular hole surgery is largely dependent on your ability to keep the gas bubble positioned correctly on the macula where it can maintain constant gentle pressure. Since the gas rises, this is best done when the eye is in a downward gaze.  Most surgeons do recommend a period of complete face down positioning and YOUR OWN surgeon is going to know your particular case best.  Always follow YOUR OWN surgeons instructions!  Some studies have shown successful hole closure without strict face down positioning, however, a downward gaze IS ALWAYS required. (Think reading position as if a book is on your lap.)  Click here for one specific 2013 study about necessary positioning. Pay particular attention to the post operative care section as well as the successful closure rates in Table 1. It is next to impossible to remain face-down 100% of the time, however, each hour spent in this position increases the likelihood of successful surgery. Our equipment is available to help you  by easing the strain on your neck, back and shoulders. 

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What is a macular hole?

A macular hole is a defect in the macula. The macula is a tiny oval area made up of millions of nerve cells located at the center of the retina. The macula is responsible for what you see straight ahead: your sharp, central vision. If you were able to look into someone’s eye through the pupil (the black hole in the middle of the colored part of your eye) you would be looking directly at the macula in the back of the eye. The photos above show an example of a normal macula (on the left) and a macular hole (on the right).  The hole is the dark circle in the middle, the larger circle to the right is the optic nerve with arteries and veins feeding the retina.  

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What are the symptoms of a macular hole?

The size and severity of the hole determines how much it will affect vision. Generally, people notice distortion and blurred vision. An Amsler grid is a very easy way to monitor central vision.  The photos above show a normal appearing Amsler grid on the left and the central "pinching" appearance from a macular hole on the Amsler grid on the right.  With a full thickness macular hole you can lose your central and detailed vision. Difficulty reading is often the first sign of a problem and frequently what brings someone to an eye care professional.

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What causes a macular hole?

Shrinking of the vitreous, a jelly-like substance that fills the eye, usually causes the hole. As a normal part of the aging process, the vitreous begins to pull away from the retina. If the vitreous is still somewhat firmly attached to the macula when it pulls away, a hole can result from the traction. Some macular holes are caused by a thin layer of tissue which forms over the macula during the vitreous aging process. This tissue is called an epiretinal membrane, but is also known as a retinal pucker or wrinkle.

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Is a macular hole the same as macular degeneration?

No.  Although they both have similar symptoms, they are two different diseases and are treated very differently.

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How is a macular hole treated?

Macular holes are treated with an outpatient surgical procedure called vitrectomy. If an epiretinal membrane is present, the tissue is gently lifted and removed. The vitreous is removed to prevent it from pulling on the retina and is replaced with a gas bubble. The bubble fills the eye and its gentle pressure on the macula helps the hole to seal. Macular hole surgery is dependent not only on the skill of the surgeon but also the commitment of the patient to post operative instruction. Following surgery, patients must maintain a face down position allowing the gas bubble to rise and press against the macula to help seal the hole. Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection, elevated intraocular pressure, and retinal detachment.

 

How successful is this surgery?

The surgery is about 90 percent effective in closing the hole with proper head positioning following surgery. However, improvement in people's vision is more variable. More than half of those who have the surgery can expect an improvement of two lines or more on the vision chart.

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What can I expect after surgery?

While the bubble is at its full size your vision will be blurry. As the bubble dissipates over the weeks following surgery your vision will improve. It is not uncommon to have some discomfort and a scratchy feeling. Your doctor will advise you of the appropriate pain reducing techniques for you. Deep ache or throbbing pain that does not respond to Tylenol or other over the counter pain relievers should be reported to your doctor. Redness, even extreme, is common and will gradually lessen over time. High elevations can cause the bubble to expand beyond a safe size and pressure for the health of the eye. You will be restricted from flying until the gas bubble has been completely resorbed.

 

Insurance Issues:

Insurance policies vary greatly between and even within companies. Please note the following...

Medicare:

Unfortunately, Medicare considers Vitrectomy Support Equipment a convenience item and will not cover its costs.

Medicare Supplements:

Secondary insurances frequently follow Medicare in determining their own policies and therefor may not cover your costs either.  We will be happy to call your insurance and inquire for you.

Commercial insurances:

Commercial insurances vary in policy and again we are happy to call and obtain your benefit information for you and will begin any preauthorization process necessary.

VETERANS:

KCS is a government endorsed provider and can be contracted through the Veterans Administration. IF CONTRACTED THROUGH THE VA THE UP FRONT PAYMENT IS WAIVED.

Summary:

Although your insurance company may cover some or all of your equipment costs, Kelly Comfort will require prepayment by you for all rentals or purchases.  Any reimbursements received will be paid directly to you.  We caution you that preapproval is not always a guarantee of full payment and urge you to purchase or rent equipment which is within your means.