Sight is one of our most important senses, essential for navigating daily life. Yet it is often taken for granted until something goes wrong.
That was what Paul Ler Seong Wei, a 47-year-old IT manager, faced when he first noticed blurry vision while looking at his computer screen. Paul was later diagnosed with a macular hole, a small break in the macula, the light-sensitive tissue in the retina responsible for sharp, central vision.
Paul recalled that it began four years ago when he noticed his vision was not as sharp as before.
“I found out there were missing areas in my vision while looking at the computer screen with my other eye covered,” said Paul.
Worried, he quickly consulted ophthalmologist Adjunct Associate Professor Au Eong Kah Guan, Medical Director and Senior Consultant at International Eye Cataract Retina Centre within two weeks of noticing his symptoms. After undergoing several tests, Paul learned that his vision problems was due to a hole in his macula.
The macula is located in the centre of the retina, the part of the eye containing light-sensitive nerve cells that allow you to see. A macular hole is an actual hole or full thickness defect in the macula and typically occurs in only one eye but has been known to happen in both in 10% of cases.
A macular hole can develop when the jelly-like substance in the eye, known as the vitreous humour, changes consistency. When this happens, it may shrink and pull on the macula, causing a small tear to form. It shares similar symptoms with age-related macular degeneration, another condition affecting the macula. Both may cause blurred or distorted central vision, wavy lines, and difficulty reading, which can progress to central blind spots over time.
“The macula is responsible for sharp, detailed central vision, which is essential for activities like reading, recognising faces, and driving,” explained Prof Au Eong. “A macular hole is a tiny break or opening that develops in this area, leading to blurred or distorted central vision. While peripheral (side) vision usually remains unaffected, a macular hole can negatively impact quality of life if not addressed.”Macular holes are considered relatively rare; however, Dr. Au Eong stated that with Singapore’s ageing population and the increasing prevalence of myopia, macular hole cases can be expected to rise. Studies have estimated the incidence of macular holes to be approximately 8-10 per 100,000 people per year globally. Paul had not been aware of macular diseases prior to his diagnosis and shared his worries upon learning the news, “I was not aware of any macular disease until I developed one myself. I found myself asking, ‘Will I go blind eventually?’”
Prof Au Eong shared that Paul’s macular hole may be primarily due to his moderate myopia, which is a known risk factor for macular hole. However, the exact cause for Paul’s macular hole remains unknown.
Fortunately for Paul, he sought medical attention not long after his symptoms appeared and was able to get his macular hole diagnosed and treated before complications could occur.
If Paul had not sought timely medical intervention, his central vision might have been permanently damaged. It is worth noting though that macular hole does not lead to total vision loss, people with the condition still retain their peripheral vision.
Prof Au Eong added, “While side vision remains, tasks requiring detailed vision, such as reading, recognising faces, or driving, can become very difficult. In rare cases, untreated macular holes can also lead to other complications, such as retinal detachment.”
Paul was initially prescribed a short course of medical therapy using eye drops, but it proved ineffective in treating his condition. Surgery was ultimately determined to be the best treatment option.
To treat his macular hole, Paul underwent a vitrectomy, a procedure in which Prof Au Eong made several small incisions in his eye to remove the vitreous humour and a thin membrane layer surrounding the macular hole. Thereafter, a gas bubble was injected into his vitreous cavity, in contact with the macula, to facilitate closure of the macular hole. The operation was performed in Farrer Park Hospital and took 90 minutes.
Vitrectomy is a standard and highly effective surgical treatment for macular holes, with a high rate of visual improvement. Many patients regain some or most of their lost vision.
Post-surgery, Paul had to make various changes to his lifestyle as he recovered and lived with the gas bubble in his eye.
For one, Paul had to keep his head in a face-down position throughout the day and night for two weeks, with intermittent breaks for meals and toilet privileges. This helped to ensure the gas bubble in his eye floated to the correct position and held the macula in place, allowing the macular hole to heal correctly. He was also prescribed eye drops to prevent infection and reduce inflammation post-surgery.
Undergoing a vitrectomy also meant that Paul could not travel by aeroplane until the gas bubble in his eye disappeared naturally in about three to four weeks. Changes in altitude can cause the bubble to expand, increasing pressure within the eye, leading to pain and possibly loss of vision.
Paul was also advised to avoid strenuous activities while his eye healed, so as not to jeopardise his recovery. He wore sunglasses whenever he went outdoors to protect against glare, and made a conscious effort to rest his eyes whenever possible. He took lutein and zeaxanthin supplements to boost his macular health. Although Paul’s vision in his right eye remains very marginally weaker than that in his left, Prof Au Eong shared that his overall recovery post-surgery was excellent. Paul attributed this exceptional recovery to his decision to seek treating early.
“I am so thankful that I sought treatment early, which contributed to my excellent recovery,” said Paul. “My vision would likely be worse than it is now if I had not noticed my symptoms and delayed my treatment.”
If you worry that you are possibly suffering from a similar condition, Paul has the following advice, “Take good care of your eyes, and if you have to undergo surgery, do your research so you’ll feel more confident about it.”
As for Prof Au Eong, he maintains that early detection is key when treating macular holes and many other eye conditions. He offers the following practical tips for those who may be worried about suffering from an eye condition:
Today, Paul remains mindful of his eye health and encourages others to take any changes in their vision seriously. His experience serves as a reminder that early detection and timely treatment can make all the difference in preserving sight.
