A 61-year-old woman presents with distorted vision in the right eye for the past month. She states that objects appear “warped” in her central vision. She denies any pain or associated photopsias. Visual acuity is 20/40 in the right eye and 20/20 in the left eye. There is no RAPD. Intraocular pressures are normal in both eyes. Motility and confrontation visual fields are full in both eyes. Anterior segment exam reveals bilateral posterior chamber intraocular lenses but is otherwise unremarkable. Slit lamp biomicroscopy reveals a small yellow ring in the center of the fovea in the right eye and a partial posterior vitreous detachment (PVD). Fundus exam of the left eye reveals a complete PVD and normal retina.

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    1. A good question. The information here is cited from the recently updated (January 5, 2020) AAO Eye Wiki:

      “Careful examination of the fellow eye (without macular hole) is recommended given that macular holes are bilateral in up to 30% of patients. (McDonnell PJ, Fine SL, Hillis AI. Clinical features of idiopathic macular cysts and holes. Am J Ophthalmol 1982;93(6):777-86). Special attention should be paid to the vitreoretinal interface, involutional macular thinning, and retinal pigment epithelial window defects because these are risk factors for MH development in the fellow eye. Patients without a PVD in the fellow eye have an intermediate risk (up to 28%) of developing a macular hole, whereas patients with a PVD are at low risk for developing a MH. (Trempe CL, Weiter JJ, Furukawa H. Fellow eyes in cases of macular hole: biomicroscopic study of the vitreous. 1986. Arch Ophthalmol 104:93–95).”

      “There are no preventative measures for idiopathic macular holes. Pars plana vitrectomy has not been clearly demonstrated to be effective in preventing macular hole formation.”

      However, if one develops metamorphosia or other signs of Vitreomacular traction or an impending macular hole in the fellow eye, there are possible medical or surgical treatment options that may improve the prognosis. You can read more about those options at the AAO Eye Wiki page cited here: https://eyewiki.aao.org/Macular_Hole

      Original article contributed by:
      Omesh P. Gupta, MD, MBA

      All contributors:
      Brad H. Feldman, M.D., Christina Y. Weng, MD, MBA, Jennifer I Lim MD and Vinay A. Shah M.D.

      Assigned editor:
      Christina Y. Weng, MD, MBA

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