Can You Get a Macular Hole When You Already Have AMD?
Having a Macular Hole and AMD at the Same Time: The Short Answer
You already have AMD (age-related macular degeneration), and now a new blur or blank spot has appeared. You may wonder if a second problem has started. The short answer is yes, this can happen. A macular hole can form in an eye that already has AMD, but only in rare cases.1 The good news is that a macular hole can often be treated. So a new change in your sight is worth a check, not a wait.
The two conditions can look similar to you from the inside, because both blur and distort the center of your vision. Telling them apart is a job for a retina specialist and a scan, not for guesswork at home. If your central vision has changed, book an eye appointment promptly so the cause can be identified. This page explains how a macular hole differs from AMD, why the two can occur together, and what treatment looks like when they do.
What a Macular Hole Is, and How It Differs From AMD
The macula is the small central part of the retina that gives you sharp, straight-ahead vision. A macular hole is a full-thickness defect in the macula.2 In plain terms, it is a small gap that opens in the tissue you use to read, recognize faces, and see fine detail. A macular hole is a rare eye condition that can blur the central vision you use for everyday tasks like driving or reading.3 It affects the center of your sight while leaving your side vision intact.
AMD also targets the macula, but the mechanism is not a mechanical gap. Wet AMD happens when abnormal blood vessels grow in the back of the eye and damage the macula.4 Dry AMD, the more common form, involves gradual thinning and the buildup of deposits in the same central area. So both diseases attack central vision, but one is a structural hole in the tissue while the other is damage from aging changes and, in the wet form, leaking vessels.
The distinction is not academic, because the two conditions are treated in completely different ways. A macular hole is often repaired with surgery that can close it, while AMD is managed with monitoring, nutrition, or injections depending on the type. Knowing which one you are dealing with, or whether you have both, is what points your retina specialist toward the right plan. That is why a scan matters more than how the change feels to you.
Why a Macular Hole Can Form in an Eye That Already Has AMD
Most macular holes start with the jelly that fills the eye, called the vitreous. As you age, the vitreous shrinks and pulls away from the retina, and this pulling can create a macular hole.3 This is a normal part of aging that usually causes no harm, but occasionally the tug is strong enough in the center to open a hole. It is a mechanical process, driven by traction rather than by the aging deposits that define AMD.
In an eye that already has AMD, the retina may be raised or distorted in places, which can change how forces act on the macula. A vitreomacular traction next to a pigment epithelial detachment can lead to a full thickness macular hole in rare cases.1 In other words, an area of AMD-related swelling under the retina can combine with the normal pull of the vitreous to open a hole. This overlap is uncommon and the evidence on it is limited, so it is described as a rare pathway, not a typical outcome of AMD.
Symptoms, and Why They Overlap With AMD
A macular hole usually announces itself slowly rather than all at once. With a macular hole, things look distorted or blurry when you look straight ahead, and later you may notice a blurred or blind spot in your central vision.3 Straight lines such as door frames or text may look bent or wavy. Your side vision stays normal, which is why some people only notice the problem when they cover their other eye.
The trouble is that AMD produces very similar sensations in the same part of your vision. In AMD, straight lines can start to look wavy or crooked, and a blurry area near the center of your vision may get bigger or turn into a blank spot.4 Because both a macular hole and AMD blur and distort central vision, you cannot reliably tell which one you have just from how it looks. That is not a failing on your part; even doctors confirm it with a scan rather than by symptoms alone.
What your symptoms can do is signal that something has changed and needs attention. A new distortion, a fresh blank spot, or a sudden step down in central vision all deserve an eye exam, whichever condition is behind them. Using an Amsler grid at home, a simple square of lines, can help you notice changes early. If new areas look wavy or missing, that is your cue to call your eye doctor.
How Doctors Tell a Macular Hole From AMD Changes
The test that distinguishes these conditions is a quick, painless scan of the retina. Optical coherence tomography (OCT) is the gold standard in the diagnosis and staging of macular holes.5 It uses light to build a detailed cross-section of the macula, showing a hole as an actual gap and AMD as its own pattern of changes. Because it images the layers directly, it can reveal a macular hole hiding inside an eye that also has AMD.
Before or alongside the scan, your eyes are usually dilated so the retina specialist can examine the macula closely. Doctors diagnose a macular hole using optical coherence tomography, a painless test that uses light waves to take detailed pictures of your retina.3 The exam and scan together tell your doctor whether you have a macular hole, AMD, or both, and how far along each one is. That full picture is what a treatment plan is built on, which is why one scan can change the whole path forward.
How a Macular Hole Is Treated When You Also Have AMD
The main treatment for a macular hole is a type of eye surgery, and it can succeed even when AMD is present. In a vitrectomy, the doctor removes the vitreous and injects a gas bubble into the eye to hold the hole closed while it heals.3 The gas bubble slowly disappears on its own over weeks as the eye refills with its natural fluid. This surgery is done by a retina specialist, the same kind of doctor who manages AMD.
Recovery from macular hole surgery involves a specific and temporary demand on your time. After the surgery you may be asked to keep a face-down position for several days, and in some cases up to two weeks.5 Holding your head down keeps the gas bubble pressed against the hole so it can seal. It is inconvenient rather than painful, and your surgical team can suggest equipment and tips that make the positioning easier to manage.
Having AMD does not mean the hole cannot be fixed, and fixing the hole does not cure the AMD. Among reported eyes with a macular hole on top of AMD, all but one hole closed after vitrectomy and the eyes experienced functional improvement.1 After the hole is repaired, your AMD still needs its own ongoing care, whether that is monitoring, AMD-specific nutrition, or injections for the wet form. Your retina specialist coordinates both so one is not neglected while the other is treated.
Success Rates, Risks, and a Realistic Outlook
The outlook for closing a macular hole with surgery is generally good. Vitrectomy has a success rate of over 90%, with patients regaining some or most of their lost vision.5 In plain terms, that means the hole closes in more than 90 of every 100 eyes. That figure is a population average, not a promise about your eye, and how much vision returns varies from person to person. Holes that are smaller and treated sooner tend to do better, which is another reason not to wait on a new change.
When AMD is also present, the ceiling on your vision may be set partly by the AMD, not only by the hole. Closing the hole removes one problem, but any macular damage the AMD has already caused does not reverse with hole surgery. This is why your retina specialist talks about realistic goals for your specific eye. The aim is usually to recover and protect as much central vision as your combined situation allows, rather than to restore perfect sight.
Like any eye surgery, vitrectomy carries some risks, and your surgeon will review the ones relevant to you. Cataract formation is common after this surgery, and less often there can be raised eye pressure, infection, or a retinal detachment. Most people accept these risks because an untreated macular hole tends to leave central vision poor. Weighing the specific risks against the likely benefit for your eye is exactly the conversation to have before deciding.
Warning Signs to Call Your Doctor About
Some vision changes should prompt a call to your eye doctor within a day or two rather than waiting for a routine visit. A new or growing blank spot in your central vision, a fresh wave or bend in straight lines, or a clear step down in your reading vision all qualify. These can mean a macular hole, worsening AMD, or another retinal problem, and each is better addressed early. Calling promptly does not mean panicking; it means giving treatment its best chance.
A few symptoms point to a possible emergency and should not wait. A sudden shower of new floaters, flashes of light, or a dark curtain moving across your side vision can signal a retinal detachment, which needs same-day care. Sudden, dramatic loss of vision also warrants urgent evaluation. If you cannot reach your retina specialist quickly, go to an emergency room, because with the retina, time affects how much sight can be saved.
Both macular holes and AMD are managed by a retina specialist, an ophthalmologist with extra training in diseases of the back of the eye. If you already see one for your AMD, that is the person to tell about any new central-vision change. If you do not, ask your regular eye doctor or primary care doctor for a referral. Keeping your scheduled follow-ups is how subtle changes get caught before they become harder to treat.
Common Questions About Macular Holes and AMD
No. A macular hole in an eye with AMD is uncommon, and most people with AMD never develop one. AMD and macular holes are separate conditions with different causes, and having one does not make the other likely. The reason this question comes up is that both affect the same central spot, so a new change can be confusing. If your central vision shifts, a scan can quickly show whether a hole has formed.
Yes. The two conditions are independent, so it is entirely possible for one eye to have AMD changes while the other develops a macular hole, or for a single eye to have both. Each eye is assessed on its own with an exam and a scan. This is one reason doctors check your central vision one eye at a time. Covering each eye in turn at home can help you notice a change that both eyes together would hide.
No, and it is important to be clear about this. Vitrectomy closes the hole, but it does not treat or cure age-related macular degeneration. After the hole is repaired, your AMD still needs its own care, such as monitoring, AMD-specific supplements, or injections for the wet form. Think of them as two separate jobs handled by the same specialist. Fixing one does not remove the need to manage the other.
That depends on your eye, and your retina specialist will advise you. Often a macular hole is repaired promptly because closing it sooner tends to give better vision, while AMD care continues around the surgery. If you have wet AMD needing injections, those may be coordinated with the timing of surgery. There is no single rule for everyone, which is why the sequence is a personal plan built from your scan and your symptoms.
Sometimes a very small macular hole closes without surgery, but this cannot be counted on. Because holes that are treated while small and recent tend to do better, doctors usually do not recommend waiting and hoping. Your retina specialist may watch a tiny hole briefly, but many holes are repaired with surgery to give the best chance of closing them. Whether to watch or operate is a decision made from your scan, not a guess.
A macular hole itself is usually not a same-day emergency, but it should be evaluated promptly rather than ignored. What can be an emergency is a retinal detachment, which shares some early symptoms like new floaters or flashes. Because you cannot tell these apart yourself, a sudden shower of floaters, flashes, or a curtain across your vision deserves same-day care. A gradual central blur is less urgent but still needs a prompt appointment.
More Questions People Ask
A macular hole after an injection for wet AMD is possible but reported only rarely, and injections remain a mainstay of wet AMD care. The far larger risk for your vision is untreated wet AMD, not the small chance of a hole. If you notice a new distortion or blank spot after starting injections, mention it so your retina specialist can scan for the cause. Do not stop recommended injections on your own out of worry about a rare event.
No, an Amsler grid cannot diagnose or distinguish these conditions, but it is still a useful early-warning tool. The grid helps you spot when straight lines start to look wavy or when a blank area appears, in either eye. What it flags is change, which is your signal to book an appointment. The actual diagnosis, macular hole versus AMD versus both, comes from an exam and an OCT scan, not from the grid.
Yes, a few factors raise the baseline risk apart from AMD. Macular holes are more common in women and in people with a very high degree of myopia or a history of eye trauma.2 Age matters too, since most macular holes occur in people over 60. None of these guarantee a hole will form, and none change the basic advice: report new central-vision changes so they can be checked with a scan.
Often some vision returns, but a full return to normal is not guaranteed, especially when AMD is also present. Many people regain some or most of the central vision they lost once the hole closes. How much comes back depends on the size of the hole, how long it was open, and any AMD damage already in the macula. Your retina specialist can give you a realistic picture for your specific eye rather than a blanket promise.
- Do I have a macular hole, AMD, or both, and what did my scan show?
- If I have both, which do you recommend treating first, and why?
- What are the chances surgery will close my hole and improve my vision?
- How will my AMD be managed before and after macular hole surgery?
- How long would I need to keep a face-down position after surgery?
- Which new symptoms should make me call you the same day?
- PMC, case series and literature review (2021). Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature.
- Cleveland Clinic (2023). Macular Hole: Symptoms, Causes, & Treatment.
- National Eye Institute (2024). Macular Hole.
- National Eye Institute (2024). Age-Related Macular Degeneration.
- American Society of Retina Specialists (2023). Macular Hole.