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Clinical Course of Macular Holes
The Eye Disease Case-Control Study
Emily Y. Chew, MD;
Robert D. Sperduto, MD;
Rita Hiller, MS;
Leila Nowroozi, MPH;
Daniel Seigel, ScD;
Lawrence A. Yanuzzi, MD;
Thomas C. Burton, MD;
Johanna M. Seddon, MD;
Evangelos S. Gragoudas, MD;
Julia A. Haller, MD;
Norman P. Blair, MD;
Marilyn Farber, PhD
Arch Ophthalmol. 1999;117:242-246.
Objective To describe the clinical course of affected and unaffected eyes in patients with idiopathic macular holes.
Patients Prospective study of patients with macular holes enrolled in the Eye Disease Case-Control Study.
Main Outcome Measures The best-corrected visual acuity at follow-up was compared with that at baseline. Changes in the macular holes, including increases in size or spontaneous regression, were assessed. The rates of development of new macular holes in fellow unaffected eyes were estimated.
Results Of the 198 patients examined at baseline, 28 (14.1%) died before reevaluation. Of those who survived, 122 (71.8%) had a follow-up examination. Approximately 34% (34.4%) of all eyes with macular holes had an increase in the size of the macular hole. Forty-five percent of eyes had a decrease in visual acuity of 2 or more lines and 27.8%, of 3 or more lines; 40.9% remained stable, with a gain or loss of fewer than 2 lines. The rate of development of a new macular hole during follow-up in fellow eyes that were unaffected at baseline was 4.3% for 3 or fewer years of follow-up, 6.5% for 4 to 5 years of follow-up, and 7.1% for 6 or more years of follow-up. Spontaneous regression of the macular hole occurred in 3 (8.6%) of 35 patients with a follow-up interval of 6 or more years, whereas no regression occurred in patients with a shorter follow-up.
Conclusions The visual acuity of 45.0% of eyes with macular holes deteriorated by 2 or more lines during follow-up. The rate of development of macular holes in unaffected fellow eyes was low.
From the Division of Biometry and Epidemiology, National Eye Institute, National Institutes of Health, Bethesda, Md (Drs Chew, Sperduto, and Seigel and Mss Hiller and Nowroozi); Manhattan Eye, Ear, and Throat Hospital, New York, NY (Dr Yanuzzi); Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (Dr Burton); Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Seddon and Gragoudas); Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Md (Dr Haller); and the University of Illinois Eye and Ear Infirmary, Chicago (Drs Blair and Farber). Dr Burton is now in private practice in Milwaukee, Wis.
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