A macular fold is a wrinkle, fold or protuberance in the macula, the part of the eye responsible for detailed sight in the central field of vision.The macula is the small area in the centre of the retina that allows us to see fine detail clearly. The retina is a layer of light-sensitive cells covering the back part of the eye like a jelly. As rays of light enter the eye, the retina turns them into signals sent through the optic nerve to the brain, where they are interpreted as images. Damage to the macula causes blurred central vision, making it difficult to perform tasks such as reading or threading a needle.
As we age, the vitreous body in the centre of the eye shrinks and pulls away from the macula. During the process of separation of the vitreous body, scar tissue can develop on the macula. Occasionally, this tissue may contract, causing the retina to wrinkle or bulge outwards.
The macula is normally flat and is stretched across the back of the eye.
When wrinkles, folds or protuberances form on the macula, sight becomes blurred and distorted, and they may even be a blind spot in the centre of vision.
Other times, the appearance of membranes occurs at sub-retinal level (underneath the retina). These membranes lift up the macula and develop new blood vessels, which lead to the so-called wet macular degeneration. In these cases, the treatment involves injecting the eye with substances that can “dry” the growth of the membrane, known as anti-VEG.
What can be done if the retina detaches?
Generally speaking, the vitreous body can separate from the retina without causing problems. But sometimes the vitreous body pulls away too strongly and tears the retina in one or two places. The liquid can leak through the tear in the retina, peeling it away from the back of the eye, in a similar way to the way wallpaper peels away from a wall. A detached retina occurs when the retina comes away from the back of the eye.
The retina cannot function when it becomes detached and vision becomes blurred. A detached retina is a very serious problem that almost always causes blindness if not treated with surgery.
In surgery to correct a detached retina, the retina is put back in place and the tear is sealed and kept in place using a laser. This surgery can be performed using scleral buckling surgery, which involves placing a band of silicon like a belt around the retina to relax the traction on it and then the tear is repaired by laser, however the most widespread technique is vitrectomy. This procedure consists of accessing the retina through three or four micro-incisions, extracting the jelly that is pulling on the retina, relaxing it and then repairing around the tear using a laser. Lastly, an element, which may be gas or silicon oil, is introduced into the eyeball to keep the retina in the correct place. In most cases, surgery enables sight to be regained and even as good as it was before the retina became detached.
It is vital to perform the right kind of surgery early enough to prevent further loss of vision.
