Stage 0 macular holes: observations by optical coherence tomography

Area of Science:

• Ophthalmology
• Retinal Imaging
• Vitreoretinal Interface Studies

Background:

• Idiopathic macular holes can affect one eye, prompting investigation into the fellow eye's health.
• Optical coherence tomography (OCT) is crucial for visualizing the vitreoretinal interface.
• Understanding early signs of macular hole development is vital for risk assessment.

Observation:

• OCT revealed vitreoretinal interface abnormalities in 28.7% of clinically normal fellow eyes.
• These abnormalities, termed 'stage 0 macular hole,' were subclassified into severe, moderate, and mild.
• Severe and moderate stage 0 macular holes showed characteristic OCT features indicating vitreous traction.

Findings:

• Eyes with severe or moderate stage 0 macular holes had a significantly higher risk of progressing to full-thickness macular holes (25% and 50% progression, respectively).
• Stage 0 macular hole presence was associated with a nearly 6-fold increased risk of macular hole formation.
• Macular hole-free survival at 48 months was substantially lower in stage 0-positive patients (54%) compared to stage 0-negative patients (94%).

Implications:

• Stage 0 macular hole, characterized by specific OCT findings of oblique vitreous traction, is a significant risk factor for developing a second macular hole.
• OCT is essential for detecting stage 0 macular holes, which are clinically undetectable.
• This finding aids in identifying individuals at high risk for macular hole development, potentially guiding future monitoring and interventions.