What is a lamellar hole?

Causes of a lamellar hole

Lamellar holes usually form as a result of changes at the interface between the vitreous gel inside the eye and the macula. Common causes include:

• Epiretinal membrane: A thin layer of scar-like tissue that contracts and pulls on the macula.
• Vitreomacular traction: When the vitreous gel sticks to and tugs on the macula instead of separating cleanly with age.
• Age-related changes: Natural thinning or weakening of the macula over time.
• Other eye conditions: Past retinal surgery, eye injury, macular degeneration, or inflammation may play a role.

Symptoms of a lamellar hole

Some people with a lamellar hole have no symptoms, and the condition may only be found during an eye scan. When symptoms do occur, they may include:

• Blurred or cloudy central vision
• Distortion - straight lines appearing bent or wavy (metamorphopsia)
• A small dip or patch of missing detail in central vision
• Difficulty with fine detail tasks such as reading or recognising faces

Peripheral (side) vision is not affected.

Lamellar hole stages

Doctors may describe lamellar holes in terms of severity:

• Early lamellar hole: A subtle split in the macula, often with little or no visual symptoms.
• Established lamellar hole: More pronounced thinning or splitting, with mild to moderate blurring and distortion of central vision.
• Advanced lamellar hole: The defect is larger and vision problems are more noticeable. In some cases, the hole may progress to a full-thickness macular hole.

Lamellar hole vs pseudohole

It is common to confuse lamellar holes with pseudoholes, but they are different:

• Lamellar macular hole: A true partial defect in the retinal layers, where some tissue is missing.
• Macular pseudohole: Caused by the pulling of an epiretinal membrane, which makes the macula appear as though it has a hole, but the retinal layers are intact.

Both can cause similar symptoms, but OCT imaging clearly distinguishes between the two.

Difference between a macular hole and lamellar hole

A macular hole is a full-thickness break in the central retina that often causes significant blurring, distortion, or a central dark spot. Unlike a lamellar hole, which only affects part of the retinal layers and may have milder impact, a macular hole goes through all layers of the macula. Because of this, it usually leads to more serious vision loss and often requires surgery to restore vision.

Do lamellar holes need surgery?

Not necessarily. Treatment depends on how much the hole affects vision:

• Observation: Many lamellar holes cause only mild symptoms and do not require surgery. Your eye doctor may recommend regular monitoring with scans.
• Surgery: If vision is significantly affected, surgery may be advised. The procedure is similar to macular hole or epiretinal membrane surgery - a vitrectomy with membrane peel.

Recovery after lamellar hole surgery

If you do decide to have a vitrectomy:

• Vision usually improves gradually over weeks to months.
• If a gas bubble is used, vision will be blocked at first but clears as the bubble shrinks.
• You must not fly or travel to high altitude until the gas has fully dissolved.
• Eye drops are required for several weeks to aid healing.
• Most people return to normal activities within a few weeks, though reading vision may take longer to recover.