Optometry case study: Full-thickness macular hole

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By Deborah Greaves, Specsavers Kawana, QLD

History

Px: 70-year-old female
Reason for visit: Rapid deterioration of vision in LE and central grey spot. RE unremarkable
GH: Hypertension, cholesterol
POH: LE mildly amblyopic
FOH: Unremarkable

Clinical Assessment

Corrected VA: R 6/6-1    L 6/24-1
IOP: R 20mmHg    L 21mmHg

Slit lamp examination:
Anterior segment: Early cataracts OU
Posterior segment: Unremarkable OU

OCT: OCT report showed full-thickness macular hole (Figures 1 and 2)

Diagnosis & Management

Diagnosis: Full-thickness macular hole
Management: Referral to ophthalmologist. By the time of ophthalmologist appointment, vision in LE was reduced to hand movements. Patient underwent vitrectomy and membrane peel. At the patient’s last review with the ophthalmologist, her retina was improving significantly in terms of central macular thickness and volume, and vision in LE had improved to 6/18-1.

Discussion

The macular area appears normal in the retinal photo, as shown in Figure 1. In cases such as these, the value of the OCT becomes evident. Upon seeing the 5 line cross in Figure 2, the diagnosis of a full-thickness hole became straightforward.

Macular holes are more common in women in their seventh decade. There are a number of causes of macular holes, including vitreous shrinkage, vitreomacular traction, diabetic eye disease, high myopia, retinal detachment, Best’s disease and trauma.

They progress from foveal detachments through partial-thickness holes to full-thickness holes. In the early stages, they can resolve without treatment. However, most full-thickness holes worsen without intervention. The other eye can also be at risk (10%) of developing a macular hole.

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