Patients in their seventh or eighth decade complaining of loss, deterioration or distortion of central vision are most likely to have age-related macular degeneration. One manifestation of macular degeneration is the development of a full-thickness macular hole. A macular hole can have a significant impact on a patient’s vision and activities of daily living. Furthermore, since 1991 macular holes have been treatable, and this possibility should therefore be borne in mind in any patient presenting with central visual problems. However, there are unique rehabilitation demands, and careful patient selection is therefore essential. This article discusses these demands, and summarises the background and treatment of macular holes. 

Age-related visual deterioration has many causes, such as cataract, glaucoma and age-related macular degeneration. A form of macular degeneration is a macular hole. Macular holes are rare (having a reported prevalence of 1 in 3300) (Ezra 2001), but the absolute number of patients with a macular hole is expected to increase as the size of the elderly population increases. Whereas macular holes are treatable with surgery, the postoperative demands on the patient are considerable and unique. In our experience after most eye operations (for example, for cataract or squint) the patient can function almost normally, and in particular is allowed to travel by aeroplane. However, this is not the case following surgery for some eye conditions, such as retinal detachment or a macular hole. This review summarises the reasons for this, and briefly discusses the issues at play in the mind of the surgeon treating macular holes.