Macular Holes: Why Some Clinicians Are Discussing Eye Drops for Selected Cases, and Why Surgery Is Still the Usual Treatment

A macular hole is a small break in the macula, the center of the retina that gives sharp, straight-ahead vision. People often notice blur or distortion in one eye, sometimes only when they cover the other. The standard treatment for many holes is surgery. A session at the American Academy of Optometry 2026 meeting explored a less common approach for selected cases.

What the session covered

Thomas Wong, OD, a professor at the SUNY College of Optometry, presented with retina specialist Ronald Gentile, MD. They reviewed the American Academy of Ophthalmology’s preferred practice guidelines and staging for macular holes, and then described a selective case series of patients whose holes responded to medical treatment aimed at reducing fluid in the retina, rather than to the traditional surgery.

The idea behind it

Dr. Wong summarized a combined “tractional-hydration” theory. Pulling forces from the vitreous gel and membranes on the retina, along with fluid swelling in the tissue, may push a hole to open or enlarge. Forces that help close a hole include the retina’s natural pumping of fluid, drying of the tissue, and the gas bubble or silicone oil used in surgery.

Based on the cases shown, he suggested that eye drops, including steroids, nonsteroidal anti-inflammatory drops, and carbonic anhydrase inhibitors, might help some holes, particularly those with fluid-filled cysts or in eyes that have already had vitrectomy surgery.

How to read this

• A selective case series means a handful of chosen patients, not a randomized trial. It cannot tell us how often drops work or for whom.
• The session was framed around “controversies,” which is a good description: this is a debate among clinicians, not a new standard of care.
• Decisions about surgery versus watching or trying drops belong with a retina specialist who has examined the eye and the OCT scans.

What you can do

Dr. Wong stressed yearly dilated eye exams, because macular holes can develop without an obvious cause and early detection gives more choices. Check each eye separately; if straight lines look bent or a dark spot appears in the center, call your eye doctor promptly. Macular holes are managed by retina specialists. For more reading, see agourahillslasik.com.

Source: AAOpt 2026: Current controversies in macular hole diagnosis, management (Optometry Times, 10/13/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.