Everything You Need to Know About Macular Pucker

Your eye functions much like a camera. It has a lens that focuses the light to create an image. The light rays bend when they enter the lens, so the image turns upside down-both on film and in your eye. You correct that upside down image during film processing, and your brain corrects the image as well.

However, your eye is far more complex than any camera ever developed. In addition to the lens, your eyes have a retina covered in special nerve cells that react to light, much like photographic film. These nerve cells sit close together in the middle of the retina where the eye focuses the images we see. This small part of the retina is the macula, and it helps us see the sharp, fine detail we need for reading and driving.

Normally, the macula lies flat against the back surface of the eye. But damage to the macular can lead to a condition known as macular pucker, or epiretinal membrane.

What Is a Macular Pucker?

To understand a macular pucker, you need to understand a little more of the eye’s anatomy. Your eye’s interior contains a gel-like s ubstance, or vitreous, consisting of millions of fine fibers. The vitreous keeps the retina in place by pressing it against the choroid.

Over time, the vitreous slowly shrinks, and the fibers pull on the retina. The fibers can break, allowing the vitreous to separate from the retina (also known as a retinal detachment). When this happens, it causes a small amount of damage to the retina’s surface.

As the eye tries heal itself, scar tissue, or epiretinal membrane, can form on the retina’s surface. When the scar tissue contracts, the r etina wrinkles, or puckers. If the scar tissue formed over the macula, the pucker causes the vision to blur and distort.

How Is It Different from a Macular Hole?

Although a macular hole and a macular pucker both cause vision distortion and blurring, they remain separate conditions. Macular holes occur when the vitreous pulls on the retina. However, if the shrinking vitreous pulls too hard, it can tear the retina, creating a hole and resulting in more serious damage.

How Is It Different from Age-Related Macular Degeneration?

Macular puckers and holes both stem from the vitreous pulling away from the retina. Age-related macular degeneration, on the other hand, occurs when deposits in the macula or the abnormal growth of blood vessels beneath the macula distort vision.

Macular Pucker Causes

Macular puckers become more common with age, especially after age 50. However, additional factors can lead to the development of a macular pucker, including:

  • Trauma from surgery or injury
  • Diabetic retinopathy
  • Inflammation and swelling (uveitis)
  • Torn or detached retina (retinal detachment)

If you’re over 50, you may want to ask your doctor if you’re at risk for macular pucker.

Signs of Macular Pucker

Macular pucker symptoms can vary. Some individuals may experience severe vision loss, while others won’t notice any changes in their vision. People with the condition may see small distortions or have difficulty seeing fine details, such as when reading small print. They may see a gray area in their vision, or perhaps even a blind spot. But typically the peripheral, or side vision, remains unaffected.

A Closer Look at the Treatment

In many cases, macular pucker requires no treatment, as it has little effect on the vision. Some people even adjust to the mild distortion.

Currently, drops, medications, and nutritional supplements have no effect on macular pucker. Occasionally the scar tissue separates from the retina, and the pucker clears up on its own.

However, severe cases of macular pucker requires surgery to remove the scar tissue. Doctors may recommend a vitrectomy, which involves removing the vitreous and replacing it with a saline solution.

Surgery Complications

Repairing a macular pucker requires delicate, precise surgery. Although vision improves in most cases, it does not always return to normal. Some estimate the procedure restores about half of the vision lost from the condition, and vision recovery can take up to three months.

Furthermore, a vitrectomy can increase the likelihood of developing cataratcs. Many individuals who undergo a vitrectomy need a cataract surgery within a few years.

Other less common complications include retinal detachment and infection after surgery. In some rare cases, the macular pucker may even grow back.

Can You Prevent It?

Macular pucker occurs with age, and currently we have no way to prevent the condition from happening. However, you can minimize vision loss if you detect the condition and seek treatment early.

Consequently, you’ll want to regularly schedule comprehensive eye exams with your doctor. He or she can then recommend surgery based on your situation. And if you experience vision loss after the surgery, your doctor can help you make the most of your remaining eyesight via low vision aids, electronic systems, and specialized lenses.