Eye Expert Witness Testimony for Macula Holes

The most delicate and important portion of the retina is the macula.  The macula is responsible for straight-ahead (central) vision and color vision.  The macula has a high concentration of visual nerve fibers, allowing it to have suitable vision for reading and seeing fine detail.  Without a functional macula, it is impossible to read, see details on faces, and see straight ahead.

Aging changes, eye trauma, or significant pulling of the vitreous jelly in the center of the eye on the macula, can pull off the macula.  The resultant macular hole may be full thickness of the retina or partial thickness (lamellar) of the retina.  The fragment of macula that is pulled away from the rest of the retina is known as the operculum.  Surgical treatment attempts to reattach the operculum to the underlying retina.

Full thickness macular holes are routinely treated with a surgical procedure involving a vitrectomy (removal of the central jelly in the eye) and gas-fluid exchange (replacement of the vitreous jelly with an expansile gas.  Anatomic restoration with closure of the macular hole is often better than 90%. However, anatomic restoration does not necessarily mean a corresponding improvement of vision. The duration and size of macular hole are important factors that influence the visual prognosis of surgery to treat macular holes.

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