Macular holes affect about 1 in 500 people, and effects women more than men. FTMHs are more common after the age of 60 and in slightly long-sighted and very short-sighted patients. It is not entirely clear why some people develop macular holes and why others don’t. Most FTMHs occur due to excessive pulling on the macula by the vitreous gel (see vitreomacular traction section). FTMHs may also develop due to eye trauma or inflammation, or if there is a history of previous eye surgery or retinal problems. Genetics, environmental factors, and systemic causes so not seem to be important in macular hole formation.