What is a Macular Hole?
The eye is essentially a camera, its camera film is known as the retina, a very specialised structure that senses and processes light. The central part of the retina is known as the macula, which is responsible for detailed central vision including reading and recognising faces. In most people the vitreous gel, which fills most of the eye, naturally and gently separates away from the retina with age. However in some people, it can be abnormally strongly attached to the macula causing pulling or traction (known as vitreomacular traction). If the traction is sufficient, it can cause a small full–thickness hole (FTMH) to form in the very centre of the macula. Because of this location, even a very small hole can cause symptoms. If the hole does not involve the full-thickness of the macula, we term it as a partial thickness or lamellar hole, and generally does not affect the vision as much as a FTMH.
Why have I Developed a Macula Hole?
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.
What are the Symptoms of a Macular Hole?
In the early stages of VMT, many patients will not have symptoms. However, by the time a full-thickness macular hole has developed, most patients will be aware of reduced central vision and distortion when looking at words or people’s faces. Straight lines may also appear crooked, and you may also be aware of a blind spot in the middle of your vision. Occasionally, some patients may only notice these symptoms when covering their good, unaffected eye or at routine review by their optometrist. Conversely, some patients are aware of symptoms even when both eyes are open together (interference).
What Tests are Required?
Macular holes are often visible when your eye is examined by your optometrist or ophthalmologist doctor. Macular holes can also often be seen on photographs of your retina. Macular holes are however best detected and classified with the use of specialist retinal imaging equipment known as an OCT scanner. Your optometrist or ophthalmology doctor may already have performed this for you. This is important in differentiating full-thickness from partial thickness holes, as these are often treated differently. The OCT scan also helps to measure the size of the hole, which influences success rates and visual prognosis, and determines whether additional steps are advised during the operation to maximise chances of success.
Benefits of Surgery
Although some very early FTMHs can occasionally just be monitored, surgery, which is the only treatment available, is advised for the vast majority of FTMHs and aims to improve your vision by closing the FTMH. It is well established that the chances of closing the FTMH and improving your symptoms of reduced vision and distortion are greater the smaller the FTMH, and the shorter the duration of symptoms. Therefore, prompt diagnosis and early surgery favour maximal gains in vision, and is generally considered gold-standard in the treatment of FTMHs. If left for a considerable time, the prognosis for visual improvement and hole closure are substantially reduced.
Macular hole surgery in my hands has a 98-100% chance of closure with one procedure, which exceeds national standards. Typically, most patients can expect their symptoms of distortion to improve or their vision to stabilise rather than progressively get worse. If operated on early enough, about 75% of patients can expect improvement in their vision by 2-3 lines of letters on the vision chart, and some may have even greater gain. Much of the improvement occurs within the first 2-3 months following surgery, but macular function can continue to improve for up to a year. Even if vision does not improve, it is much more likely to stabilise and not further deteriorate, and surgery will allow your two eyes to work better together without interference. For a small minority of people, vision could be worse and may require further surgery. It is important to appreciate that even with fully successful closer, your vision will not be as good as before you developed a macular hole. The vast majority of people who have undergone surgery are pleased that they did so.
What does Surgery for Full-thickness Macular Hole Involve?
Surgery for the repair of a FTMH is called vitrectomy. I exclusively use the latest generation micro-incisional keyhole surgical equipment to perform this operation. Through just 3 tiny incisions, each only approximately 0.5mm in length, the vitreous gel is delicately removed from the eye allowing access to the FTMH. Using very delicate forceps, a very fine retinal membrane which is only 1/400th of a millimetre thick is gently lifted and peeled from around the FTMH. This is the most critical and delicate part of the procedure. Following this, a gas bubble is injected into the eye which naturally absorbs over a period of a 2-8 weeks, depending on which gas was used in your operation (see gas in the eye FAQ). Removing the vitreous gel and retinal membrane, in combination with gas injection allow the FTMH to close. Because the incisions required using this specialised keyhole equipment are so small, sutures will not be required in most cases. Routine surgery is usually performed under local anaesthetic and can be performed in as little 20-40 minutes. If you feel you will be very anxious during the procedure, I have access to an excellent team of private anaesthetists who will be able to administer additional sedation or even general anaesthesia as required, in order to make the procedure as comfortable as possible for you. (See anaesthesia options FAQ)
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Testimonials
Over 99% of patients rate me with 5*
Kam Balaggan is a splendid fellow and I would recommend him to anyone who needs eye surgery. My optician referred me to him when my cataracts were getting too bad to ignore. I’m glad she did. I found him to be a man whom one can engage with and trust, not only to give solid advice but to perform operations with great skill. That’s important because, after all, one only has one pair of eyes. At the first appointment, Mr Balaggan tested my eyes with some very up-to-date instruments and told me about an anomaly that I hadn’t previously been aware of. He was able to recommend some special lenses that could correct it and what he said made a lot of sense. That’s the thing – what he tells you makes sense and you know he’s not just going through the motions. Both operations went well (one for each eye, obviously) and there was no discomfort during or after surgery. None of those bad things that could theoretically happen, did happen and I was very happy. Mr. Balaggan had already explained that it might take some months for the trifocal lenses to settle in and for vision to improve, and that is exactly what is happening. I’m not left worrying or wondering what is going on.
I was diagnosed with cataracts and had the cataracts removed (Feb/March) and lens implant. I now have perfect long vision. I no longer need to wear contact lenses or glasses the first time for over 50years. I cannot thank Mr Balaggan, Alex and his team at Nuffield Wolverhampton for their professionalism. Following my initial consultation Mr Balaggan explained the procedure and gave me every confidence in him. Thank you so much.
Firstly an apology for the lateness of this review. I thought about it when I was looking back over the most positive things I have done in the last decade. Without a shadow of doubt having lens replacement surgery is the single best thing I have done in my life full stop. This may seem a bit gushing but I have had extremely poor eyesight all my life (+9) and dreaded the day my optician told me I couldn’t wear lenses again Thank you Tracy Taylor of Taylor Biddle for recommending Mr Balaggan. I cannot thank you both enough. To wake up every morning and see clearly without grappling for a pair of glasses still gives me so much joy. Only wish is that I’d done it sooner. Thank you Mr Balaggan and if you want me to speak to anyone who may be considering surgery I’d be more than happy to. Ever grateful.
I certainly would have no hesitation in recommending Mr Kam. His knowledge and experience gave me full confidence from square one and the actual procedures carried out including the Epiretinal Membrane removal was fully effective and minimal in any negative effects. He and his Secretary were fully co-operative regarding delays incurred because of my Wife’s condition, which was very much appreciated.
I am delighted with the results of this procedure and would commend it to anyone who would potentially benefit from it. Mr Balaggan is a very kind and empathetic man who can put you at your ease, provide all the necessary information and reassurance you need as well as his experience and expertise in this type of eye surgery. The process can undoubtedly be unnerving but the benefits are incredible.Inevitably there is some temporary pain and discomfort and a degree of mild inconvenience, but those elements are short lived. I can now see close, middle and far distance clearly without the need for glasses. What a wonderful outcome!
Dear Mr Balaggan
Following on from my recent procedures for Cataract Treatment please accept this little note as a huge THANKYOU to you and all of the Team at Spire Little Aston for an excellent experience, one that I was not expecting or looking forwards to!
The care given throughout both procedures was nothing short of brilliant.
Like most people would be, I was petrified of eye surgery and the thought of me having to go through it literally made me feel weak in the stomach.
However, following our initial consultation you immediately put me at ease. In particular both my husband Brian and I were very impressed with how thorough you and your team were and the way that you calmed me down by explaining the procedure without putting the “fear of god” into me.
My vision is now almost perfect thanks to you.
Believe me, It’s not very often that I take to the Internet to offer praise, however, in this instance it’s only fair to do so.
I would have no hesitation in recommending you and your team to any potential patients that may come to you in the future for assistance.
Thanks Again
I feel so lucky to have been referred to Mr Kam Balaggan in my hour of need and I have no doubt whatsoever that his professionalism, urgency and compassion has literally saved my sight. I have no central vision in my left eye due to chronic CSR, and in April suffered a giant tear with detachment in my only seeing right eye. My consultant recognised this as an urgent optical emergency which if not treated immediately would result in loss of vision in both eyes. I am relatively young and still in full employment. Such was the urgency that she would only refer me to someone she trusted implicitly – that was in the evening of 11 Apr and Mr Balaggan operated on me at 0700 the next morning before his scheduled full day of surgery! I can say no more than I have never encountered in any field such a level of professionalism and technical expertise combined with real care and compassionate attention. I will always feel indebted to Mr Balaggan for the successful restoration of my vision – what more can I say?
In 2017, I was diognosed with Posterior Vitreous Detatchment ( PVD), more commonly known as floaters. For two years this condition adversely affected my quality of life, to the point that I was unable to continue my employment of over twenty six years. I feel that unless you suffer, or have suffered from PVD, it is very difficult to comprehend how it can impact upon your day to day life. I had been constantly advised that there was nothing that could be done, and basically I would have to “live with it”.
Thankfully on 5th November, Mr Balaggan successfully completed vitrectomy surgery on my right eye. To say that I was nervous is an understatement, given the risks that are associated with any surgical procedure.
All went smoothly, and the care I received was absolutely first class. The recovery time was only 2-3 weeks, and the operation has been a complete success. The floaters have gone and I am overjoyed – I have my life back !
I cannot thank Mr Balaggan enough – not only is he a true gentleman, kind, caring and compassionate, he is a true expert in his field. I would 100 percent recommend him to anyone who is experiencing this problem, as the result will transform your life.
Thank you so much Mr Balaggan – you are amazing.
For last 4 years I (48yr old) have suffered debris (floaters & floating capsule) trapped in my central vision on my main eye. This has led to obstructed vision, depression and low mood. I had been told on numerous occasions nothing could be done and ‘to live with it’. On 13/02/20 Mr Balaggan did a vitrectomy and removed ALL floaters. I have my life back – dreams have come true!! My vision has been transformed…so sharp and colourful. I have had a long history of issues/operations and seen numerous top surgeons around the country from Moorfields (London) to Oxford but so pleased to have found Mr Balaggan here on my doorstep. Mr Balaggan is a true expert in eyes, kind caring and compassionate. 100% recommend.
I was given Mr Balaggan’s name by Benenden Health when my ophthalmologist referred me for specialist examination Mr Balaggan has a friendly manner and is easy to relate to. He explained my situation and the options available to me I feel comfortable being in his care.
Originally having private cataract surgery on both eyes ,although not at the same time, I came to know Mr Balaggan as a top rate ophthalmic surgeon. Later a tear on the retina was successfully treated by Mr Balagganat Wolverhampton eye hospital. Having later having had had a detached retina Mr Balaggan has been instrumental in restoring my eye sight. Very friendly and competent consultant who puts patients at ease. Explanations clearly given to any items of concern. I thoroughly recommend Mr Balaggan for any eye problems.
Mr Balaggan performed very successful (and life-changing) lens replacement surgery on both my eyes with the primary purpose of correcting extreme myopia. He is highly professional and experienced and obviously extremely skilled. He was open and approachable at all times and I felt fully informed, reassured and supported throughout the whole process. I am very grateful for his care and expertise and would not hesitate to recommend him to anyone seeking ophthalmic treatment.
I had a vitrectomy 11 months ago under the care of Mr Balaggan as I had suffered with chronic floaters that had stopped me from performing my daily activities. From my initial consultation to the post operative follow up consultation I found Mr Balaggan to be very kind and professional, explaining all the options open for me and carefully listening to all my concerns. The vitrectomy was a great success! His skill was evident as there was little to no pain following the procedure and very little redness on the eye. Being free of the floaters was amazing my vision was wonderfully clear. Yesterday Mr Balaggan performed cataract surgery for me on the same eye! I was extremely nervous but he was once again was amazingly kind, patient and very accommodating. Mr Balaggan and his team did everything in their power to make me comfortable during the surgery. His expertise and skill shone through as the surgery went very well even with my previous eye history. I didn’t feel any pain and felt very confident in Mr Balaggans safe hands. He made time to speak to me twice before discharge. Already today, day 1 post op, I feel great seeing improvement in my vision already! I have just realised how dull my vision was with that cataract everything is bright now! Can’t wait now to get the second eye done! If you need any eye surgery Mr Balaggans the man you can trust to do the job!!
I required three eye operations in total (all anticipated) and everything went according to plan. Mr Balaggan is clearly an expert at what he does but also has the ability to put you totally at ease about what is going to happen. Not only has Mr. Balaggan succeeded in arresting a potentially sight-threatening problem in my one eye but I now also have near perfect long distance vision in both eyes for the first time in nearly 50 years. Definitely a success!
Dr Kam and his team carried out cataract surgery for my grandmother at the Nuffield Hospital on November 2019. Due to her being diagnosed as partially blind, she had been told on numerous hospital visits that removing the cataracts from her eyes would be too risky and would not make much difference to her sight. She had completely lost hope that her sight would ever improve. However Dr Kam and his team managed to achieve this. The level of care and compassion shown before, during and after the operations was exceptional. The improvement in vision my grandmother has seen is amazing. Thank you.
Mr. Balaggan is a highly qualified and experienced eye surgeon who works to the highest professional standards, as do all the staff encountered in the clinic. He performed two painless eye operations on me with excellent results. He has been very pleasant, meticulous, and taken time listening and in giving clear explanations. I was immediately put at ease. Pity he doesn’t do knees.
Firstly an apology for the lateness of this review. I thought about it when I was looking back over the most positive things I have done in the last decade. Without a shadow of doubt having lens replacement surgery is the single best thing I have done in my life full stop. This may seem a bit gushing but I have had extremely poor eyesight all my life (+9) and dreaded the day my optician told me I couldn’t wear lenses again Thank you Tracy Taylor of Taylor Biddle for recommending Mr Balaggan. I cannot thank you both enough. To wake up every morning and see clearly without grappling for a pair of glasses still gives me so much joy. Only wish is that I’d done it sooner. Thank you Mr Balaggan and if you want me to speak to anyone who may be considering surgery I’d be more than happy to. Ever grateful.
Having any form of treatment to my eyes was my worst nightmare and when my eyesight became distorted due to a lifted membrane over my retina, I ignored my referral for a year before I simply had to do something. I wish I had contacted Mr Balaggan earlier. Seven months later the membrane is removed and cataracts treated in both my eyes and now I no longer fear eye surgery. This is not only due to Mr Balaggan’s expertise and professionalism but also the way in which he makes you feel at ease. I trust him completely and he and the team around him provide an environment in which you feel safe in their hands.
I had very poor eyesight from birth and self refered to Mr Balaggan. Mr Balaggan was very curtious, and extreemly thorough in his assess ment tests, My clear lense replacement has given me a new lease of life. BETTER than 20/20 vision in both eyes. After care was just as thorough making sure everything had gone as planned and had settled well. I cannot thank Mr Balaggan enough.
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Advantages of Private Macular Hole Surgery
“Your surgeon is the biggest factor in the outcome of your treatment”
I am an experienced full-time NHS Consultant who specialises in complex vitreoretinal and cataract surgery.
I have performed approximately 3000 vitreoretinal procedures, and personally perform and supervise approximately 300 retinal operations a year, including routine and complex retinal detachments.
I am one of the most highly–trained Vitreoretinal Surgeons in the Midlands, having completed 2 years of subspecialist high-volume vitreoretinal training fellowships at Moorfields Eye Hospital in London, one of the World’s Top Eye Hospitals. I am the Director of Vitreoretinal Surgery in my current NHS Hospital.
I will personally perform your initial and post-operative assessments, and will provide you with all the time you require in order to answer your questions and alleviate any fears and anxieties.
I will personally perform your surgery, rather than a trainee surgeon which is not uncommon in non-private settings (in particular in Teaching Hospitals).
You will have direct access to me from the outset, thereby circumventing some of the more traditional route requiring you to be seen by an optician and general ophthalmologist prior to being reviewed by a vitreoretinal surgeon.
As a private patient you may bypass any local NHS waiting lists for non-urgent surgery, resulting in accelerated treatment.
At all stages of your treatment pathway, you will receive my direct access telephone number. This will negate the need to go via any third party, such as a secretary or the hospital, in order to obtain any routine or urgent advice. I will be available 7 days a week for you in this regard. This is a very important aspect to the service I pride myself in providing, giving you the reassurance and confidence to make your journey through this difficult time as smooth and anxiety-free as possible.
This and all other aspects of the service I provide have resulted in very high satisfaction levels from my former patients, rating my service an average of 4.9/ 5 on Trustpilot.