My Suggestions for Patients Having Macular Hole Surgery

Question Your Retinal Surgeon about Vitrectomy Surgery

• Be informed, and don’t be afraid to ask questions. Be polite, respectful, and assertive about your concerns and needs.
• Ask how many vitrectomies your doctor has performed for macular holes. Experience counts. Choose a doctor who has performed this surgery many times.
• How frequently does your doctor perform this surgery?
• What is their success rate in terms of the hole closing and staying closed and in terms of eventual visual recovery?
• Ask how your doctor defines success.
• Many retinal surgeons measure their success in anatomical terms: Does the hole close? Does the hole remain closed?
• However, the other measure of success is in functional visual terms: What kind of visual acuity is restored/achieved? Is there visual distortion (and to what degree) following recovery from the surgery?
• What are the surgical risks?
• What does your doctor think may happen if you do not have surgery?
• Be sure that the doctor (not a medical resident) will perform the surgery.
• Get a second opinion if you have questions or concerns or are uncomfortable with the answers you receive.

More Questions for Your Doctor

• Ask your surgeon to discuss other treatment options, including the opportunity for macular hole closure and the associated visual benefits.
• If you have other eye problems or conditions, such as macular degeneration, diabetic retinopathy, or glaucoma, ask your retinal surgeon if these conditions present any risks for the vitrectomy procedure.
• See Questions to Ask Your Eye Care Specialist for additional questions and concerns to ask your eye doctor.
• Ask about face-down positioning, including recommendations and reasons for those recommendations.
• Ask about getting authorization for face-down vitrectomy equipment, including a letter stating that this equipment is “medically necessary.” Such a letter can help with reimbursement for face-down services and equipment.
• Try to get your doctor to state that the equipment and services (such as physical therapy) are “medically necessary.” If your insurance company denies you, file an appeal. Several readers wrote about being denied initially but winning due to filing an appeal.
• See Suggestions for Maintaining Face-Down Positioning After Macular Hole Surgery for in-depth equipment suggestions for the face-down positioning recovery period.

If Vitrectomy Surgery Is Indicated

• Stay on your doctor’s radar to have it scheduled as soon as feasible.
• The best results are with small macular holes of short (less than six months) duration without underlying eye disease.
• In the shorter duration, the photoreceptors remain but are “curled under” into the macular hole. With the repair of the macular surface, the photoreceptors can return more or less to where they’re supposed to be, and function can return.
• See Some Facts about the Retina for more information about the photoreceptors and their function.
• In longer-duration holes (1 year or more), there is missing macular tissue; macular hole closure is much less likely, and full visual restoration also is unlikely.
• Check with your health plan to see if it will cover the face-down equipment and have a massage or physical therapist visit your home.

How to Advocate If You Have Problems Getting an Appointment for Surgery

• Be polite and respectful – but assertive – about your need to be seen by a retinal surgeon.
• Ask if there is a waiting list for cancellations.
• Call every day for an appointment, if necessary. Ask about being seen in place of cancellation or “no-show.” (In rare instances, people have waited daily in the doctor’s waiting room, hoping for a cancellation.)
• Write a letter addressed to the retinal surgeon’s attention (polite, worried, and intelligent) requesting a quick appointment. Explain how important this is to you. Explain that you will be fully cooperative with whatever you have to do to maximize the results.
• An urgent request from another doctor may carry more weight than a patient’s. Ask the ophthalmologist who first diagnosed you to intervene with the retinal specialist, stating that you must get an appointment.
• If you have special needs for good visual acuity, such as occupational or professional needs, add that to the letter, explaining that your vision is needed for your work.
• If you are not a senior and have a macular hole, specify that you have many productive work years ahead.

After Vitrectomy Surgery

• Monitor both your operated eye and your non-operated eye.
• Notify your doctor promptly if you have pain in your eye, an increase in floaters, a loss of visual field, a decrease in visual acuity, or a significant image size discrepancy between your two eyes.
• See Floaters, Retinal Tears, and Retinal Detachments and Signs and Symptoms of Vision Problems for more information about potentially serious eye and vision changes.
• Follow your eye drop regimen faithfully to reduce/prevent serious inflammation. See Tips for Taking Eye Drops for helpful eye drop tips and techniques.
• Be aware of drug complications, even with eye drops.
• Be sure to ask your doctor to check your eye pressure since some eye drops can cause increased eye pressure in some people.
• Don’t disregard unusual symptoms, such as exhaustion. Always notify your doctor.
• If you have been diagnosed with an epiretinal membrane or a macular pucker in the second eye, go to the doctor as soon as your vision changes. Ask about the advisability of surgery before your vision worsens.

Cataract Surgery Following Vitrectomy

• Cataract surgery, which usually follows a vitrectomy, is generally safe. Still, there are risks, including infection, retinal detachment, inflammation, and macular edema (swelling or accumulation of fluids in the macula).
• Generally, your doctor will not perform cataract surgery until after the eye has healed from the vitrectomy.
• Find a cataract surgeon who has experience with vitrectomy patients. Cataract surgery with a vitrectomy patient is more challenging and requires extra time and skill.
• Be sure to take your eye drops exactly as prescribed following cataract surgery.

Updates in Macular Hole Treatment and Recovery

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

A Disclaimer

I was an educator of blind and low-vision children for 42 years. Although I have read and researched extensively and have had extensive discussions with retinal specialists, I am not an ophthalmologist or a medical doctor.

Reviewed by Mrinali Patel Gupta, M.D., VisionAware Medical Consultant. Reviewed by author, August, 2023.