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 over a 95% chance of closure with one procedure. 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.