How a Macular Pseudohole Differs from a Macular Hole

Joy Efron
Joy R. Efron, Ed.D.

What Is It?

  • Macular hole: A true hole in the retina. This means that layers of the retina are absent. You can read more about macular hole at Surviving Recovery from Macular Hole Surgery.
  • Macular pseudohole: Not a true hole; rather it is a condition in which scar tissue called epiretinal membrane tugs or pulls on the underlying retina, which can look similar to a macular hole during a clinical eye examination.
  • However, a detailed examination, as well as more advanced imaging, such as optical coherence tomography (OCT), demonstrates that there is, in fact, no hole and no missing retinal layers.

[Editor’s note: OCT is a type of medical imaging technology that produces high-resolution cross-sectional and three-dimensional images of the eye.]

Role of the Epiretinal Membrane

  • Macular hole: Epiretinal membrane tissue may or may not be present. It is not involved in the formation of a macular hole.
  • Macular pseudohole: The epiretinal membrane (ERM), which can pull on the underlying retina, is the cause of the retinal contraction that gives the appearance of a hole.
  • Please note: The epiretinal membrane (ERM) can have varying degrees of retinal cone disruption from none or minimal to significant. The degree of this cone disruption affects the final visual outcome. Pseudohole is simply an appearance of the retina due to contraction (or pulling) from the ERM. Studies suggest no difference in visual outcome between ERM with pseudohole and ERM without pseudohole.

Causes

  • Macular hole: Caused by a strong pulling forward of the macular area of the retina by vitreous fibers as they contract. The vitreous is the jelly-like substance that fills the inside of the back part of the eye. Traction on the retina by the overlying internal limiting membrane also contributes to macular hole formation.
  • Macular pseudohole: Caused by traction (but a lesser amount of pulling than in a macular hole) of the epiretinal membrane.

Effect on Vision

  • Macular hole: Blurring and distortion
  • Macular pseudohole: Blurring and distortion, but to a lesser degree than with a macular hole

Progression

  • Macular hole: Will progress without surgery
  • Macular pseudohole (and the associated epiretinal membrane): In many cases, does not worsen

Surgical Intervention

  • Macular hole: Vitrectomy (removal of the vitreous), usually with peeling of the internal limiting membrane. There is insertion of air or gas, followed by a face-down period of recovery.
  • Macular pseudohole: Vitrectomy (if vision has deteriorated sufficiently) with peeling of epiretinal membrane. Infrequently there may be the insertion of air or gas, followed by a face-down recovery period.

Vision Recovery

  • Macular hole: Vision recovery is typically good, usually improvement of two lines or better, as measured by the Snellen Eye Chart. Vision recovery can take a year or longer.
  • Macular pseudohole (and epiretinal membrane): Vision recovery is good and can take a year or longer.

Important Advice to All Readers

Monitor your vision in both eyes carefully and see your ophthalmologist promptly if conditions change. This is particularly important if you have had a macular hole, a pseudohole, or have been diagnosed with an epiretinal membrane.

Additional Information on Macular Pseudohole

Also see Suggested Resources for more information about helpful products and organizations, as well as the author’s contact information.

A Disclaimer

I was an educator of blind and visually impaired children for 42 years. Although I have read and researched a great deal and have had extensive discussions with retinal specialists, I am not an ophthalmologist or medical doctor.

Reviewed and edited by Mrinali Patel Gupta, M.D., VisionAware Medical Consultant

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