Posterior Segment
Macular Hole
Also known as: macular hole, full-thickness macular hole, FTMH, foveal hole, central scotoma, metamorphopsia
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Macular hole is a foveal structural defect, commonly presenting with central blur, distortion, or a central scotoma. OCT is the key investigation. Optometry role is recognition, OCT staging where available, fellow-eye risk awareness, and referral to retinal specialist care.
Recognition
Symptoms: what patients report
- Central blur or missing central spot.
- Metamorphopsia or distortion on near tasks.
- Usually painless and monocular at presentation.
Signs: what the examination shows
- OCT may show a full-thickness foveal defect with elevated retinal edges.
- Foveal contour is disrupted rather than simply thickened.
- Fundus examination may show a small round foveal lesion or loss of foveal reflex.
What OptoGuide™ covers for macular hole
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Macular Hole — EyeWiki
- Vitreomacular traction and macular hole — College of Optometrists CMG
- Idiopathic Macular Hole Preferred Practice Pattern®. Kim SJ, Lim JI, Bailey ST, et al. Ophthalmology. 2025;132(4):P234-P269.
- Clinical characteristics and optical coherence tomography findings in epiretinal membrane, macular pseudohole, epiretinal membrane-foveoschisis, and lamellar macular hole. Kubota N, Miyata K, Mori Y, et al. PloS One. 202
- Pars Plana Vitrectomy With Internal Limiting Membrane Flap Versus Pars Plana Vitrectomy With Conventional Internal Limiting Membrane Peeling for Large Macular Hole. Ghoraba H, Rittiphairoj T, Akhavanrezayat A, et al. The
- Centre for Eye Health — Chair-side Reference: Vitreomacular Interface Anomalies
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.