Macula - Clinical Significance

Clinical Significance

Whereas loss of peripheral vision may go unnoticed for some time, damage to the macula will result in loss of central vision, which is usually immediately obvious. The progressive destruction of the macula is a disease known as macular degeneration and can sometimes lead to the creation of a macular hole. Macular holes are rarely caused by trauma, but if a severe blow is delivered it can burst the blood vessels going to the macula, destroying it.

Visual input from the macula occupies a substantial portion of the brain's visual capacity. As a result, some forms of visual field loss can occur without involving the macula; this is termed macular sparing. (For example, visual field testing might demonstrate homonymous hemianopia with macular sparing.)

In the case of Occipitoparital ischemia owing to occlusion of elements of either posterior cerebral artery, patients may display cortical blindness (which involves blindness that the patient denies having, as seen in Anton's Syndrome), yet display sparing of the macula. This selective sparing is due to the collateral circulation offered to macular tracts by the middle cerebral artery. Neurological examination that confirms macular sparing can go far in representing the type of damage mediated by an infarct, in this case, indicating that the caudal visual cortex (which is the principal recipient of macular projections of the optic nerve) has been spared. Further, it indicates that cortical damage rostral to, and including, lateral geniculate nucleus is an unlikely outcome of the infarction, as too much of the lateral geniculate nucleus is, proportionally, devoted to macular-stream processing.