Visual performance in idiopathic macular holes

Previously published reports on the clinical features of idiopathic macular holes highlight the predilection for post-menopausal women and implicate vitreomacular traction in the aetiology of these lesions. Relatively little attention, however, has been paid to the quality of visual loss in eyes with macular holes. Histological studies of full-thickness macular holes have shown loss of all retinal layers in the area of the hole, and this would be expected to produce a central absolute scotoma of the same diameter. The majority of patients with full-thickness holes in this series did not have an absolute scotoma large enough to be detected on the Amsler Chart or when reading. It is suggested that following formation of a macular hole, enlargement may occur without further loss of foveal tissue and without enlargement of the absolute scotoma, due to tangential vitreous traction or contraction of an associated epiretinal membrane.