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Simulate idiopathic macular hole (MH) — a full-thickness defect in the central fovea caused by tangential vitreous traction on the foveola, producing a characteristic central scotoma, metamorphopsia (distortion), and sudden reduction in central visual acuity. Macular holes are classified by the four-stage Gass system (revised 1995): Stage 1 (impending hole — foveal pseudocyst / yellow foveal spot or ring from tangential vitreous traction without full-thickness loss), Stage 2 (small full-thickness hole, <400 µm, with vitreous attachment, bridging pseudo-operculum), Stage 3 (full-thickness hole, >400 µm, with visible operculum, vitreous still attached to the opercular fragment — greatest risk of visual loss from outer foveal cone degeneration), and Stage 4 (full-thickness hole of any size with complete posterior vitreous detachment [PVD] confirmed by Weiss ring on the detached posterior hyaloid). Macular holes affect approximately 3 per 1,000 adults over age 55, with a strong female predominance (female:male ratio approximately 3:1). Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling under chromovitrectomy (using vital dyes such as membrane blue, triamcinolone, or brilliant blue G) and gas tamponade (SF6 or C3F8) achieves hole closure in 80–95% of cases with visual acuity recovery to 6/12 or better in most patients with Stage 2–3 holes of short duration. Model three clinical stages: Stage 1-2 impending/small hole (foveal pseudocyst and small full-thickness defect), Stage 3 full-thickness hole with operculum (active vitreous traction), and Stage 4 large hole with complete PVD (maximal central visual loss). Inspect central scotoma-induced ΔE colour shift, CIE xy chromaticity, and image-level simulation of foveal defect visual distortion.

Macular hole colour science simulation by Auric Artisan.

Base color
Macular hole stage & settings
Severity / visual loss 50%
Image simulation
Upload JPG/PNG (max 1200 × 1200). See how a scene appears with a Stage 1-2 foveal pseudocyst with traction distortion, Stage 3 full-thickness central scotoma, or Stage 4 large hole with complete PVD and maximal central visual field loss.
Research notes
Idiopathic macular hole was first systematically classified by J. Donald Gass in 1988 and revised in 1995. The Gass hypothesis — tangential vitreous traction on the fovea as the primary mechanism — was initially controversial but has been comprehensively validated by OCT imaging since the 1990s. Modern high-resolution OCT reveals the precise foveal anatomy at each stage: the inner limiting membrane (ILM), which provides the framework for vitreous adhesion, plays a central role in MH pathogenesis. ILM peeling during PPV releases the tangential traction vectors driving hole formation and propagation, and stimulates Müller cell-mediated foveal remodelling that facilitates hole closure. Without surgery, Stage 2–4 holes rarely close spontaneously (<5% for Stage 2; essentially nil for Stage 3-4). The inverted ILM flap technique (Michalewska et al., 2010) has improved closure rates for large holes (>400 µm) that may not close with standard ILM peeling alone.
Swatches
Normal
HEX: — • RGB: — • xy: —
MH affected
HEX: — • RGB: — • xy: —
ΔE (CIE76)
—
ΔE (CIEDE2000)
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Deep preview
Normal
MH (deep)
Chromaticity (CIE xy)
Central foveal scotoma chromatic shift toward achromatic
D65 white point: 0.313, 0.329
Image simulation

Macular hole simulations model the central scotoma and metamorphopsia of idiopathic foveal defects using a foveal cone loss model in the sRGB colour space. Stage 1-2 (impending/small hole) is modelled as a central contrast reduction and mild distortion reflecting the anatomical disruption of the foveal photoreceptor mosaic from inward tangential traction and pseudocyst formation — without complete foveal loss. Stage 3 (full-thickness hole, >400 µm) models near-complete central foveal cone signal depletion — the fovea lies within the hole; the colour response models parafoveal (residual ring) contribution only. Stage 4 (large hole with PVD) represents the most severe central scotoma — the entire 5-degree central foveal field is compromised. Periacuolar metamorphopsia (distortion from retinal oedema at hole margins) is approximated as a hue rotation in the surrounding parafoveal region. ΔE2000 per Sharma et al. (2005). Not for clinical diagnosis — macular holes require OCT (essential diagnostic tool), Amsler grid, and vitreoretinal surgery evaluation. Any new central vision distortion, central grey spot, or straight line distortion requires urgent ophthalmology evaluation.

Multi-condition comparison
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Compare Stage 1-2 impending/small hole traction distortion, Stage 3 full-thickness central scotoma, and Stage 4 large hole with complete PVD. Image simulation applies a central foveal scotoma mask with peripheral contrast reduction to uploaded scenes.