Macular Hole, or Macular Pseudohole
- Feb 5
- 2 min read
Updated: Mar 4
When does a hole qualify as a hole, and when is it not a hole? What is a macular pseudohole?
A macular pseudohole is an optical illusion on retinal imaging where the center of the macula looks like a hole—but the retinal tissue is actually intact.
What causes it?
Most commonly caused by an epiretinal membrane (also called ERM)—a thin layer of scar tissue on the retinal surface that contracts and pinches the macula, creating a steep contour that mimics a hole.
Pseudohole vs. true macular hole
Pseudohole
Retina is not fully broken
Caused by surface traction (e.g. epiretinal membrane or ERM)
Often stable and less severe
True macular hole
A full-thickness defect in the retina
Usually due to traction from the vitreous (a jelly occupying the space in the posterior eye) pulling the retina apart
More likely to cause significant vision loss and may need surgery
Symptoms of a macular pseudohole
Mild to moderate blurred or distorted central vision
Straight lines may look slightly wavy (metamorphopsia)
Many patients have minimal symptoms, especially early on
How can we tell? One of the commonly used diagnostic tools we have at our disposal is the Optical Coherence Tomography equipment, which allows us to image the retina at a high resolution, allowing us to see the individual layers of the retina. For those more technically inclined:
Macular pseudohole
Steep, narrow foveal contour that looks like a hole
No full-thickness retinal defect—all retinal layers are present
Epiretinal membrane seen on the surface, often with retinal wrinkling
The outer retinal layers (ellipsoid zone) are intact
True macular hole
Full-thickness gap from inner to outer retina
Clear interruption of outer retinal layers
Often cystic changes at the edges
May see vitreomacular traction or an operculum
Have concerns about a hole? Let us make the diagnosis whole. Contact us today!
