October 2026 - Armadale Eye Clinic

Words that look faintly smudged in the centre of the page, or straight lines that seem to bend when you look directly at them, can be signs of a lamellar macular hole. You may find these changes are easier to spot with one eye covered, or that reading small print takes more effort than it used to.

This condition affects the fovea, the small central point of the retina responsible for sharp, detailed sight. Knowing how it is identified and when treatment for retinal conditions is considered can help you make informed decisions about your eyes.

Quick Overview

A lamellar macular hole is a partial-thickness defect at the centre of the macula, where some retinal tissue is lost.
One explanation links it to changes in the vitreous gel as it separates from the retina.
It is found mostly in older adults and frequently occurs alongside epiretinal proliferation.
Management ranges from monitoring with retinal scans to vitrectomy surgery.

Below, we explain how it is identified and what treatment involves.

What Is a Lamellar Macular Hole?

A lamellar macular hole is a gap that extends only partway through the fovea. Tissue is lost from the inner layers of the retina, and in some eyes, the outer retinal layers are also affected. Unlike full-thickness macular holes, a lamellar hole has no complete break through every layer.

Many lamellar holes have lamellar hole-associated epiretinal proliferation on the retinal surface. This tissue differs from a typical epiretinal membrane, which is a thin film that can contract and wrinkle the macula.

What Symptoms Can a Lamellar Hole Cause?

Most patients with a lamellar hole notice slight central blur or distortion in the affected eye. Not everyone has symptoms, and some lamellar holes are only picked up on a retinal scan.

How Is a Lamellar Macular Hole Diagnosed?

Diagnosing a lamellar macular hole relies on optical coherence tomography, a scan that shows the retina in cross-section. On the scan, the foveal contour looks irregular rather than forming the normal smooth dip of the central fovea, and there is a cavity with undercut edges in the inner fovea.

Your ophthalmologist also measures your visual acuity. A clear clinical diagnosis helps distinguish a lamellar hole from a macular pseudohole, where an epiretinal membrane changes the shape of the fovea but no tissue is lost. Repeat scans help determine whether anything changes.

What Causes a Lamellar Hole, and Who Does It Affect?

The exact cause is not fully understood, and a lamellar hole is often described as idiopathic, meaning no clear trigger is found. One explanation for its development is that traction from the vitreous, as it separates from the retina, removes part of the inner fovea without creating a full hole. In a recent surgical study, patients had an average age of 72.

Does a Lamellar Macular Hole Get Worse?

Many lamellar holes stay stable for years, while others show slow progression. Eyes that are monitored without surgery tend to lose vision gradually on average. A small number of lamellar holes develop into a full-thickness hole, leading to a more noticeable loss of central vision.

When Is Surgery Considered for a Lamellar Macular Hole?

Surgery is typically considered when vision is declining, distortion is getting worse, or scans show the hole is changing. In a vitrectomy, the vitreous gel is removed, any epiretinal proliferation or membrane is lifted, and the thin inner lining of the retina may be peeled to relieve traction.

For lamellar holes with epiretinal proliferation, pooled data from 17 studies found vitrectomy was associated with improved visual acuity, while observed eyes showed little change. A full-thickness hole formed in 7.5% of eyes after surgery and 4.2% under observation, without a clear difference between the two groups.

The surgical outcome depends on your individual situation. Your vision before surgery can contribute to how much it improves, and damage to the outer retinal layers is one of the risk factors for a full-thickness hole forming afterwards. Like any eye surgery, vitrectomy carries risks, and your ophthalmologist will explain these before you decide.

Lamellar Macular Hole Care at Armadale Eye Clinic

Because a lamellar macular hole can stay stable or change slowly, treatment decisions rely on how your vision and scans compare over time. At Armadale Eye Clinic, our vitreoretinal surgeons assess lamellar holes and provide both ongoing monitoring and vitrectomy surgery. They can explain your scan results and whether surgery may suit you. To arrange an assessment with our ophthalmology team, please call us on (03) 9070 5753.

Frequently Asked Questions

Can a lamellar macular hole affect both eyes?

Yes, a lamellar hole can be present in one eye or both. It helps to have both eyes examined, even if symptoms affect only one.

Can glasses correct blurred vision from a lamellar hole?

Glasses focus light onto the retina, but they cannot replace lost retinal tissue. An updated prescription can help with blur from a change in focus, but not with distortion caused by the hole.

Can I still drive with a lamellar macular hole?

Driving depends on whether you meet the national medical standards for driving for your licence type, which assess how clearly and how widely you see rather than the diagnosis itself. Your ophthalmologist can measure your vision against those standards.

What is recovery like after vitrectomy for a lamellar hole?

A gas bubble is often placed in the eye, and you may need to keep your head face down for a few days. Your vision stays very blurred until the gas is absorbed, and you cannot fly until it has gone. Sight can keep improving gradually over many months.

Is a lamellar macular hole the same as macular degeneration?

No, they are separate conditions. Macular degeneration involves a gradual loss of cells in the macula or abnormal blood vessels that leak into it, while a lamellar hole is a loss of tissue in the fovea. A scan tells them apart, and each is treated differently.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

References

https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1156410/full

https://www.health.nsw.gov.au/outpatients/referrals/Pages/macular-hole.aspx