When to refer macular hole
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Macular hole referral is driven by new central distortion, reduced acuity, and OCT or fundoscopy suggesting foveal defect or traction.
- Symptom duration matters because earlier retinal input is generally more useful than delayed referral.
- Differentiate full-thickness hole suspicion from vitreomacular traction, lamellar change, or other macular pathology.
- Refer promptly when OCT or symptoms suggest a new macular hole process.
Common causes
- Full-thickness macular hole.
- Vitreomacular traction.
- Lamellar macular hole.
- Epiretinal membrane with central distortion.
Red flags (must not miss)
- New central distortion or missing spot.
- Reduced acuity not explained by media or refraction.
- OCT showing foveal defect or traction.
- Progressive unilateral central symptoms.
Use OptoGuide™ to guide this decision during consult.
What to check
- Monocular acuity and symptom timing.
- Amsler-type distortion history.
- Macular OCT where available.
- Fundus view for foveal change, cuff, or traction pattern.
- Other causes of central reduction such as AMD or oedema.
When to refer
- Prompt retinal referral for suspected new macular hole or significant vitreomacular traction.
- Earlier referral when acuity is dropping or OCT changes are clear.
- Routine monitoring only when the finding is stable and not functionally significant.
Initial management
- Separate central distortion from more general blur early in the history.
- Use OCT to distinguish tractional macular disease from other central pathology when available.
- Document laterality, acuity, and symptom duration clearly for referral.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.