VMT, Lack of PVD are Risk Factors of Bilateral Macular Holes

Multivariate analysis confirmed that VMT increased the risk of fellow-eye FTMH by 12-fold compared to eyes with PVD and fourfold compared to eye without PVD. These findings reinforced the concept that persistent VMT is a key pathogenic mechanism in FTMH formation and bilateralization. Photo: Vardaan Sood, OD. Click image to enlarge. Full-thickness macular hole (FTMH) is a major cause of central vision loss, predominantly affecting the elderly, with an average onset age of approximately 65 years and a higher prevalence among women. It is usually idiopathic, arising spontaneously with no identifiable systemic or ocular disease. Reported rates of bilateral involvement vary widely. However, the relative contribution of these risk factors and the true incidence of bilateral FTMH remain incompletely defined.Researchers based in Paris sought to estimate the incidence of FTMH bilateralization, identify the key risk factors associated and compare the surgical outcomes between the first and second affected eyes. Their recent study found that the presence of vitreomacular traction (VMT) emerged as the strongest predictor of fellow-eye FTMH. Eyes with VMT demonstrated a markedly higher incidence of bilateralization, reaching 27% at two years. Moreover, macular holes developed earlier in eyes with VMT, with most occurring within one year.This retrospective case series, which was published in Ophthalmology Retina, used clinical records and spectral-domain OCT to assess FTMH characteristics, bilateralization and vitreoretinal interface status in the fellow eye, including posterior vitreous detachment (PVD), VMT, epiretinal membrane and lamellar hole.Among 576 patients (mean age, 67.2 years), 34 (5.9%) developed a fellow-eye FTMH over a mean follow-up of 27.3 months. The cumulative incidence was 4% at one year and 12% at five years. Eyes with VMT had a markedly higher risk, reaching 19% at one year and 27% at two years and developed FTMH earlier than eyes without VMT. In multivariable analysis, VMT was the strongest independent predictor of bilateralization (odds ratio: 12.9). Despite structural retinal changes and a higher prevalence of PVD in myopic eyes, neither axial length nor high myopia influenced bilateralization risk; however, given the limited number of high-myopic eyes and events, the study was not powered to exclude a moderate clinically relevant association. Holes in fellow eyes were smaller and had better visual acuity at diagnosis, but final visual acuity and closure rates were comparable to the first eyes.“These findings support close fellow-eye surveillance, particularly in eyes with VMT, and reinforce the importance of patient education regarding early visual symptoms to enable timely intervention,” the study authors concluded in their paper.Click here for the journal source. Canizares L, Abdelmassih Y, Chapron T, et al. Incidence and risk factors of full-thickness macular hole in fellow eyes. Ophthalmol Retina. April 10, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.