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Optometry Infographic: Stages of Macular Hole Development

Posted by Amanda Dexter on November 28, 2016 at 9:00 AM
Amanda Dexter
Dr. Amanda K. Dexter received her optometric training at Southern California College of Optometry in Fullerton, California, where she was Class of 2010 Valedictorian. She also completed a residency in Primary Care and Ocular Disease at the Veteran's Affairs Hospital in San Diego, California. Dr. Dexter is the Manager and Program Coordinator for OptoPrep, the premiere online study resource for the NBEO Part I & II.


We continue with our Optometry Infographics series with our latest on the stages of macular hole development.

Stage 1 Macular Hole (or impending MH): Localized contraction of the perifoveal vitreous causes a tractional detachment of the fovea resulting in a loss of the foveal contour. Stage 1 holes are characterized clinically as a small round yellow spot or ring in the fovea.  Visual acuity is usually better than 20/50. 

Stage 2 Macular Hole: This stage is marked by a small full-thickness retinal break (<400 µm in diameter). This can occur weeks to months following Stage 1 MHs (approximately 50% progress to Stage 2). A further decline in visual acuity is also noted (20/50 to 20/80 range). In most cases, the posterior hyaloid has been confirmed to be still attached to the fovea on OCT analysis. 

Stage 3 Macular Hole: Further progression to a fully developed macular hole that is usually approximately 1/3 disc diameter in size (≥400 µm in diameter). Nearly 100% of stage 2 MHs progress to Stage 3 and the vision further declines to around 20/200. A grayish macular rim often denotes a cuff of subretinal fluid and drusen-like deposits are often observed at the base of the hole. The posterior hyaloid is noted to be detached over the macula with or without an overlying operculum. 

Stage 4 Macular Hole: A fully developed macular hole with a posterior vitreous detachment. The risk of developing a macular hole in the fellow eye is as high as 15%.

Be sure to check out our other fact posts!


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