AAOpt 2026: Current controversies in macular hole diagnosis, management

Thomas Wong, OD, FAAO, a professor at the SUNY College of Optometry, describes a session he presented with retinal specialist Ronald Gentile, MD, FACS, FASRS on current controversies in diagnosing and managing macular holes. The AAOpt 2026 presentation, titled “Macular Holes: Current Controversies in Diagnosis and Management,” focused on a selective case series of patients with macular holes who responded favorably to medical treatment aimed at reducing cystoid hydration, rather than receiving the more traditional surgical treatment. The speakers also reviewed the Academy of Ophthalmology’s preferred practice guidelines and staging for macular-hole diagnosis and treatment.

Wong summarizes a combined tractional-hydration theory of macular-hole development and closure. In this account, disruption of the fovea centralis is a pivotal event. Factors that may promote a hole’s progression include hydration and tractional forces involving the internal limiting membrane, epiretinal membranes, and vitreous. By contrast, factors that may support closure include the retinal pigment epithelium pump, dehydration, and tamponade from a gas bubble or silicone oil. Based on the cases presented, Wong suggests that topical medical therapy may be useful for some full-thickness macular holes, cases involving cystoid hydration, and eyes that have previously undergone vitrectomy. The treatments mentioned include steroids, nonsteroidal anti-inflammatory drugs, and carbonic anhydrase inhibitor drops, with several specific medications and concentrations named in the talk.

The discussion then turns to optometrists’ role in identifying and managing eye disease. Wong says that macular holes can occur spontaneously and argues that yearly dilated eye examinations are important for detecting early-stage disease, when appropriate management may be possible before progression. He characterizes optometrists as key members of healthcare teams and compares their role in eye care to that of internal medicine physicians. In Wong’s view, they should identify problems, educate patients, and maintain good working relationships with specialists to whom they refer patients.

Finally, Wong emphasizes continuing education and patient advocacy. He encourages optometrists to attend meetings, keep up with the literature on pharmacologic and surgical approaches to macular holes, and become familiar with relevant guidance from professional organizations. Wong also notes the value of educating patients and colleagues about current approaches, while acknowledging that patients may advocate for treatments they have learned about themselves.