My Recovery and Visual Outcomes from Macular Pseudohole Surgery

Retinal surgeons are now using a faster-acting gas than they did a few years ago. They have learned that the hole closes much faster than they had thought previously.

However, there have been no studies that I could discover about vision recovery relative to a slow-acting gas (long face-down period) versus a fast-acting gas (short face-down positioning time).

Though there are successful reports of hole closure with the fast-acting gas, there is minimal information about the relative effects of the length of gas exposure on vision recovery.

How to Measure Success?

Many surgeons tend to measure success anatomically: Did the hole close? Did it remain closed?
My other vital concern is functional success: How much vision will I recover? What will be the quality of my recovered vision?

It takes at least a year to know how much vision will be recovered. Statistics report that 50% of people improve two lines or more on the Snellen visual acuity chart. I am incredibly fortunate (and was incredibly compliant with face-down positioning). My visual acuity in my left eye, from my first macular hole surgery, is 20/25 without glasses. My visual acuity in my right eye, from my pseudohole surgery, is 20/30.

I feel strongly, however, that this 20/30 measurement is not a functional visual acuity measurement. There are tiny missing pieces (blind spots) in my vision in my right eye and my brain has to fill in what is missing.

When functional vision presents a problem, patients need to

Determine whether further surgical intervention or other medical treatments may be of help
Make sure their eyeglass prescription is correct and optimal
Check with a low vision clinic to learn if low vision devices can help.

Visual Results After My Vitrectomy for a Pseudohole

My surgery involved a vitrectomy, peeling of the internal limiting membrane, and insertion of an air bubble. My surgeon had warned me that my vision post-surgery would be worse than pre-surgery for a couple of months. Furthermore, the final results from pseudohole surgery are typically not as good as final vision recovery from a macular hole, even if the macular hole is full-thickness.

I have divided my recovery into four phases:

Phase One

This was the time from surgery until the dissipation of the air bubble. This was expected to dissipate quickly. However, mine took 10 days, during which time I was face-down.

Phase Two

This phase was a gradual increase in healing and visual functioning for about 4-5 months. A week after the vitrectomy, the best visual acuity measurement in my right eye was a poor 20/400. (Visual acuity in my left eye, which was operated on three years earlier for a macular hole, was 20/25).

Eleven days after the vitrectomy, my visual acuity was a little better than 20/200 and, with a pinhole lens (which is supposed to be predictive of the eventual visual recovery), it was 20/40. The surgeon was pleasantly surprised as I achieved that acuity despite inflammation, blood, debris (from surgery), and the beginnings of a cataract. I also tried using binoculars and could see quite well at a distance. However, there were tiny blind spots in my central vision when trying to read with the right eye.

[Editor’s note: A pinhole lens is an opaque disk with one or more small holes through it, used to test visual acuity. The pinhole testing device can determine if a problem with visual acuity is the result of a refractive error, such as nearsightedness, and thus correctable with regular glasses, or due to a disease process that is not correctable with regular glasses.]

Phase Three

This phase was a gradual decrease in my visual functioning as the cataract developed. Before cataract surgery, my visual acuity had dropped to 20/400. However, with the pinhole lens, I measured an amazing 20/30, despite tiny central blind spots. Parts of letters were missing, but it was better than it had been before the pseudohole vitrectomy.

Phase Four

This phase was my cataract surgery, nine months after the vitrectomy, followed by improvement over a period of six months to a year. You can read more about my cataract surgery after my vitrectomy at Complications I Experienced Following Vitrectomy.

After Pseudohole Surgery: My Visual Recovery

A year after my pseudohole surgery, I tested 20/25 or 20/30 in the operated eye. While that numerical measurement may be reflective of distance vision, I don’t feel that it is a functional measurement. My 20/25 or 20/30 measurement has been achieved … hesitantly, you could say. I have to turn my head or my eye to the side and use my brain to approximate or fill in missing details.

I have tiny blind spots in the central vision of the operated (right) eye and so there is some blurring and portions of letters are missing, which my brain has to fill in. Initially, this was very troubling when I tried to read: Is it an “R” or a “B”? Is it a “v” or a “y”? “The tail of the letter is not clear.” This improved greatly with time, familiar material, and using context clues. Now, to read, I depend primarily upon my left eye.

Please note: With tiny blind spots in central vision, the brain can fill in missing elements in familiar material by using context clues. This does not work as well with unfamiliar material, such as foreign languages, unfamiliar symbols, telephone numbers, and small print. Practicing moving the eyes and head (called scanning); magnifying the print, with either a magnifier or electronically; and using appropriate lighting can improve visual efficiency.

I wonder—but will never know—if I would have had fewer blind spots and better results if my surgeon had been able to operate sooner. Visual acuity from epiretinal membrane/pseudoholes usually does not worsen and therefore, most surgeons are reluctant to operate unless and until vision deteriorates. If you are in a similar situation, be sure to discuss this with your surgeon.

I would not like to read if I had to depend on my right eye because it requires a lot of work. However, I am not complaining and consider myself to be very fortunate. My brain can fill in missing material and my left eye is so good that I can totally depend upon it for reading.

My Final Results

My visual acuity in my left eye, which was operated on for a macular hole in 2009, is almost 20/20 without glasses (some days 20/20; some days 20/25). I tend to wear my glasses when driving at night or when reading in dim light.

My visual acuity in my right eye, which was operated on for a macular pseudohole in 2012, is 20/30 without glasses and 20/25 with glasses. There are still some tiny central blind spots that do not interfere with distance vision but do interfere with reading. However, my dominant left eye takes over and so I have no concerns.

Additional Information on Macular Pseudohole

Also see Suggested Resources for more information about helpful products and organizations, as well as the author’s contact information.

A Disclaimer

I was an educator of blind and visually impaired children for 42 years. Although I have read and researched a great deal and have had extensive discussions with retinal specialists, I am not an ophthalmologist or medical doctor.

Reviewed by Mrinali Patel Gupta, M.D., VisionAware Medical Consultant