Part One: Introduction to Surviving Recovery From Macular Hole Surgery
Joy R. Efron, Ed.D.
Below is the first of a five-part series, "Surviving Recovery From Macular Hole Surgery." This section contains a brief description of the author's experience, plus some basic information about macular holes, macular hole surgery, and recovery.
The purpose of this article is to offer hints and tips to assist in "surviving" the difficult post-operative period following macular hole surgery. The suggestions presented here were very beneficial to me during my post-operative phase. With adaptation for individual needs, I hope that many of these ideas may be of value to anyone who is preparing for macular hole surgery. The required face-down positioning following surgery was extremely uncomfortable and challenging for me. However, maintaining that position is, I believe, one of the main reasons that my recovery was successful.
"Remaining face-down for six weeks would not have been possible for me without the assistance of others, face-down positioning equipment, mentoring and encouragement by others who have gone through macular hole surgery, and support of family and friends."
The information provided here is based on my own experience and research, and the advice of my doctors and former patients. You should always seek out and follow the advice and guidance of your own doctors.
Throughout the article, various products and equipment are mentioned; the Resources section provides additional information about these items. Since I live in Southern California, some of these resources are specific to that region of the country.
Following 42 years as an educator of blind and visually impaired children, it was a great surprise to me to suddenly experience a visual impairment on a first-hand basis. While driving in January 2009, I became aware that the painted highway lane markers appeared to be extremely wavy when viewed through my left eye. Everything (whether near or far) was blurry. A visit to the ophthalmologist determined that I had a full thickness macular hole (through all layers of the retina).
During the two months between diagnosis and surgery (March 2009), my vision continued to deteriorate. Every horizontal and vertical line appeared to have at least five "S" curves. The city looked devastated, with buildings at eccentric angles. At times, while I was looking at a person, it would suddenly appear as if his or her head had shrunk to a miniscule globe. Items appeared smaller with my left eye than with my right eye.
Scanning became extremely difficult, e.g., while walking in a grocery store, items on shelves appeared to be jumbled together. While trying to read, letters were skewed and wavy. Letters became smaller while reading across a line of print. My corrected visual acuity had deteriorated from normal to less than 20/200. All visual tasks had become fatiguing and additional lighting had become critically important.
The eye is filled with a gel-like substance called vitreous, which helps maintain the shape of the eye. As people age, the vitreous starts to shrink away from the retina. This is normal and usually causes no problems. In isolated cases (about three per 1,000 people over the age of 60), some resilient fibers refuse to let go of the retina. Essentially, a tug-of-war takes place with the body of the vitreous shrinking while the "stubborn" fibers hold tight to the retina. This tug-of-war can cause a hole in the macula, the area of central vision in the retina. Once a hole is formed, the body's defenses create scar tissue on the retina. The hole and the scar tissue cause blurriness and visual distortion. A macular hole should not be confused with macular degeneration or a retinal detachment. Detailed information on macular holes is available on the Internet.
A macular hole is characterized by blurry vision (both near and far) as well as visual distortion.
Surgery consists of a vitrectomy (removal of the vitreous), peeling of the retinal scar tissue, and insertion of a gas bubble in place of the vitreous. Usually, those who have had macular hole surgery will also need cataract surgery within a year.
Over several weeks, the pressure of the gas bubble causes the hole to close. Since gas rises and the macula is located at the back of the eye, the patient must be face-down following surgery for the gas bubble to be properly positioned to exert the necessary pressure on the macula.
Follow your doctor's recommendations for face-down positioning during recovery.
I could find no definitive research relative to either the number of hours per day or the total number of days a patient must be face-down. Some doctors suggest two to three days; others suggest six weeks or until the gas dissipates. Through networking with friends and professionals, I spoke with individuals, from Massachusetts to Hawaii, who had gone through macular hole surgery. Based on their informal reports, there appeared to be a dramatic correlation between visual outcome and the number of hours per day and the total number of days spent face-down.
Based on my doctor's recommendations and my own research, I was face-down for six weeks following surgery. For the first 29 days, this meant face-down positioning 24 hours per day, with the only exceptions being four brief periods per day when I rolled onto my back for eye drops. For the last 14 days, I was face-down at night and during most of the day; face-up periods were brief.
The face-down period was extremely unpleasant, but I was goal-directed and determined to do everything in my power to contribute to the best possible visual results following surgery. Patience, perseverance, and determination paid off.
The gas bubble causes a cataract (in patients who have not previously had cataract surgery). Thus, a follow-up cataract operation is required, usually within six months to a year following the macular hole surgery.
According to the literature, most patients get some visual improvement following surgery, but outcomes vary greatly among patients. It can take a year before maximum visual improvement is achieved.
One year post-surgery, my visual functioning has far surpassed expectations. Visual acuity in my post-surgery eye is 20/25, with very minimal (insignificant) distortion, and image size is essentially the same with both eyes.
Copyright © 2010, Joy R. Efron, Ed.D.