Idiopathic Macular Hole

Publication Date: February 1, 2020
Last Updated: March 14, 2022


Macular holes are more common in females than in males and usually occur after age 55. There is a high rate of macular hole formation in the fellow eye (10%-15%) in the 5-year period after a macular hole occurs in the first eye.

Patients with vitreous traction and no macular hole (stage 1-A or 1 -B) should be observed without treatment, because they often remain stable or even improve. Currently, there is no evidence that treatment improves the prognosis.

Most patients with stage 2 to 4 macular holes will have a poor prognosis without treatment. The visual prognosis is good following successful macular hole closure. The benefits of treatment designed to achieve macular hole closure should be discussed.

Studies report that approximately 90% of recent macular holes that are ≤400 μm can be closed with vitrectomy surgery.

The early detection of a macular hole is associated with both a higher closure rate after vitrectomy surgery as well as better postoperative visual acuity.

Careful removal of the internal limiting membrane (ILM) during vitrectomy surgery increases the macular hole closure rate without adversely affecting the visual acuity.

Cataract is a frequent complication of vitrectomy surgery to repair macular holes. This risk should be discussed with patients preoperatively, and postoperative monitoring is advised. (, , )

Recommendation Grading




Idiopathic Macular Hole

Authoring Organization

Publication Month/Year

February 1, 2020

Last Updated Month/Year

July 28, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

Identify patients at risk for macular hole. Educate high-risk patients about the reason for periodic monocular self-assessment and follow-up examination, the symptoms of a macular hole, and the need to return promptly should symptoms occur. Follow patients who are at risk for vision loss from macular hole. Inform patients of the risks and benefits of the treatment options for macular hole. Optimize recovery of visual function.

Target Patient Population

Patients 55 years of age or older

Inclusion Criteria

Older adult

Health Care Settings

Emergency care, Hospital, Outpatient

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D008268 - Macular Degeneration, D008269 - Macular Edema, D005128 - Eye Diseases


macular hole, macular disease, eye disease

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.026


Number of Source Documents
Literature Search Start Date
April 1, 2018
Literature Search End Date
June 1, 2019