Diagnosis
Care Process
Î The initial evaluation of a patient with symptoms and signs suggestive of
macular hole includes all features of a comprehensive adult medical eye
evaluation, with particular attention to those aspects relevant to macular
hole. (II++, G, S)
Î A complete history includes: duration and location of symptoms, ocular
history, and medication use that may be related to macular cystoid edema.
(III, G, D)
Î Physical examination includes slit-lamp biomicroscopy of the macula
and vitreoretinal interface, and the optic disc to rule out an optic pit or
advanced cupping. (III, G, S)
Î Physical examination also includes an indirect peripheral retinal
examination and an Amsler grid test. (III, G, S)
Î OCT offers detailed information about the anatomy and size of the macular
hole and the presence of vitreous traction or an epiretinal membrane, all
of which aid in the diagnosis, staging, and follow-up. (III, M, D)
Î The initial evaluation should include a careful assessment of the fellow
eye. (III, G, S)
Î It is important to diagnose a macular hole in the fellow eye as soon as
possible, and patients should be educated about warning signs such as
metamorphosia or mild decreases in central visual acuity. (III, G, S)
Î OCT may also help to identify at-risk eyes evident by vitreous traction at or
near the center of the macula. (III, In, D)
Table 3. Idiopathic Macular Hole (Initial Evaluation and Therapy)
Initial Exam History (Key Elements) Initial Physical Exam (Key Elements)
• Duration of symptoms • Visual acuity
• Ocular history: glaucoma, retinal
detachment or tear, other prior eye diseases
or injuries, ocular surgery, or prolonged
sun or eclipse gazing
• Slit-lamp biomicroscopic examination
of the macula, vitreoretinal interface,
and optic disc to rule out an optic pit or
advanced cupping
• Medications that may be related to
macular cystoid edema (e.g., systemic
niacin, topical prostaglandin analogues)
• Indirect peripheral retinal examination
