Macular Pucker

A macular pucker is a membrane on the surface of the macula that can adversely affect central vsion.

What is a Macular Pucker?

The macula is the center of your retina. It is responsible for your straight ahead vision. While reading the print on this page, you are using your macula. The cornea and lens in the front of your eye focus the image of these words onto your macula. The macula converts the light from the image on this page into a neurological signal that is processed by your brain. When an extra layer of tissue forms on the retinal surface and then contracts to distort the central retina, we call it a macular pucker. A macular pucker is sometimes called an epiretinal membrane, cellophane maculopathy, a wrinkle, preretinal fibrosis or pseudomacular hole. Macular puckers are present in about 10% of people over the age of 50. They usually caused by a layer of vitreous--the gel that fills the eye--condensing on the surface of the retina and changing into a membrane. They look like a piece of scotch tape. Some macular puckers contract and pull the macula enough to cause distortion in the central vision. When this happens, patients can consider vitrectomy for macular pucker.

What are the symptoms of macular pucker?

The most common symptoms of macular pucker are distortion and vision loss. In is important to realize that other, more serious and more acute disorders can also cause distortion. If you experience new distortion in your vision, DO NOT ASSUME YOU HAVE A MACULAR PUCKER. You may have something more serious. You should consult a physician as soon as possible (less than a week) if you have new onset distortion and vision loss in either eye. Sometimes when one eye has a serious vision problem the other eye will take over and you may not notice the problem. Therefore, it is important to check your eyes separately every day to make sure that each eye is seeing well.

What is a macular pucker evaluation?

The diagnosis of a macular pucker is established by an eye examination and confirmed with ancillary testing. A dilated examination of the macula using a silt lamp (microscope) can usually establish the diagnosis of a macular pucker. Optical coherence tomography (OCT) is a useful tool for assessing the microstructure of the macula. A low energy laser is swept across the macula and a computer uses the reflected light to reconstruct the layers of the retina. An OCT scan will also show a macular pucker and can establish how the macular pucker is distorting the macular structure. Fluorescein angiography can show distortion of vessels in an eye with a macular pucker. It is also sometimes used to eliminate the possibility of other diagnoses, like wet age-related macular degeneration and retinal vein occlusion.

What is the Natural history of macular pucker?

Macular puckers are usually stable. They generally form and affect vision over a time period of about 3 months and then rarely change. One study followed 84 patients with macular pucker for a year, half with cataract surgery and half without, and there was virtually no change in any of the patients’ macular puckers. Visual acuity and retinal thickness was minimally worse at one year in some patients.(Eye. 23(4):774-9, 2009)

A population-based study of people living in the Blue Mountains west of Sydney, Australia, was performed following all people living in that area for common eye diseases. This study identified, by photography, 2 types of macular pucker – one type that caused retinal folds (premacular fibrosis) and one type that did not cause retinal folds (cellophane maculopathy). At the studies inception, 56 participants (62 eyes) had premacular fibrosis. The lesions progressed in 16.1% of eyes and regressed in 25.8% of eyes. Of the 142 participants (183 eyes) with cellophane maculopathy, the area of involvement decreased in 12.6% of eyes and disappeared in 13% of eyes.(Ophthalmology 2003;110:34–40)

A clinic based study showed that 15% of patients with macular pucker have visual acuity of worse than 20/70. The same study showed no further loss of vision after enrollment in 87% of 47 eyes followed without surgery for 2 to 4 years.(Ann Ophthalmol. 1982;14:876-8)

Several studies have shown that about 25% of people with macular pucker in one eye will develop a macular pucker in the fellow eye.

What are the options?

If you have been diagnosed with a macular pucker you can live with it, wait, have surgery, or if applicable, seek treatment of other disease affecting your vision.

Live with it: Macular puckers are not uncommon. If your vision is not affected by the macular pucker, you do not need surgery. Macular puckers rarely progress. If your macular pucker does progress, you can opt to have it operated on when that happens. If your vision is minimally affected by the macular pucker, you have to weight the risks and benefits of surgery. These are discussed further in the surgery section of this site (see link below). Everyone has different visual needs. There are people who cannot work if there vision is minimally compromised and there are people who get along fine with relatively poor vision. You need to decide what is right for you.

Wait: Since macular pucker surgery is successful at improving vision within the first few years of onset of the macular pucker, there is no harm waiting a little while to decide. About 5% of macular puckers improve with time, about 80% stay the same, and about 15% worsen. Usually if they worsen, they do so within the first few months of onset. So waiting a few months is rarely dangerous. Comparing serial optical coherence tomography scans over time can help you gauge if your macular pucker is changing.

Have Surgery: If you are bothered by your vision and want to have surgery for the macular pucker, there is no benefit to waiting. Although it is OK to wait to have surgery, it is not necessary. You are probably a little better off having surgery sooner than later if you are sure that is what you want. The benefit of surgery probably does gradually decline over time while the risk stays the same. There is no way to tell if your macula has been permanently damaged by the macular pucker. Eighty percent of people improve with surgery, 15% don’t change and about 5% worsen. If your vision is affected to the point where your eye is not seeing well and your visual function is poor, then surgery is a reasonable option.

Seek treatment of other diseases affecting your vision: Many macular pucker patients have other eye diseases, like cataract, macular edema, and retinal vein occlusion. If you have a concomitant treatable eye disorder, treatment of that disorder might improve your vision enough that your visual function is satisfactory to you and you do not need the macular pucker removed. An added benefit of cataract surgery prior to macular pucker surgery is that it makes the macular pucker surgery technically a little easier and probably safer.

What is Vitrectomy for Macular Pucker

Vitrectomy for macular pucker improves the vision in patients 80% of the time about half way to normal. Since, the surgery, like any surgery, has some risks, most surgeons only recommend surgery for patients with significant visual symptoms. If a person with a macular pucker is having trouble reading, driving, or doing whatever they want to do visually surgery can be helpful. Usually this occurs when the visual acuity drops to 20/70 or less. Some patients with visual acuity between 20/40 and 20/70 have symptoms severe enough to warrant surgery. Usually when the vision is better than 20/30 surgery is not recommended because the risk of surgery can outweigh the potential benefits. Without intervention, only about 10 to 25 percent of eyes with macular pucker suffer progressing visual acuity loss. Macular pucker surgery is never an emergency. Macular puckers can be removed within a few years on onset with good visual results. In general the sooner a macular pucker is removed, the more likely the vision will improve. Still there is no harm waiting a few months before considering the operation. A small number, about 5 percent, of macular puckers will spontaneously peel and vision will improve. Most macular puckers are stable.

Video Macular Pucker Surgery

65 year old woman with 20/50 vision for about a year. Vision improved to 20/25 1 week after surgery.

Video Macular Pucker Surgery

This 65 year old woman has had decreasing vision for 6 months from a macular pucker. The visual acuity is 20/200. The patient had cataract surgery 6 months ago and the vision is still hazy and distorted from the macular pucker. Vision improved to 20/30 6 months after surgery.

Video Macular Pucker Surgery

This 60 year old man with 20/400 macular pucker and vision loss over about a year. Vision was 20/80 at 1 month follow-up visit. High definition video - very thick macular pucker (epiretinal membrane).

Macular Pucker NEWS

Below are current articles from a Google News Feed on Macular Pucker

Ala Moshiri  The Conversation US

I am a clinician scientist working as an ophthalmologist and retina surgeon, as well as an laboratory basic scientist researcher studying genetics of eye disease.

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Global Vitrectomy Systems Market to Witness Stellar Revenue Growth Across Top Regional Pockets | Kentucky Breaking News Updates  Kentucky Journal 24

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Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker  Healio

Ocular Surgery News | Objective measures of contrast sensitivity and visual distortion can be used to assess the impact of macular pucker on visual function, ...

Statins to help prevent scar tissue in the eye?  Science Daily

According to a new study, statin medication seems to reduce the risk of repeated surgery in patients who undergo a vitrectomy to treat a detached retina.

Global Retinal Pharmaceuticals Market 2019-24 Santen Pharmaceutical Co.,Ltd., Regeneron Pharmaceuticals,Inc  Bitcoin Journal

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Study Finds Opticians Misdiagnose Eye Disease  AARP News

Opticians misdiagnosed approximately 25% of patients who showed signs of Age-related Macular Degeneration, an eye disease that affects adults over 50.

BLOG: Macular issues can reduce acuity in cataract patients  Healio

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Global Optical Coherence Tomography (OCT) Market Outlook 2017-2026 - Insufficient Clinical Data and Lack of Reimbursement Facilities are Inhibiting the Market Growth  GlobeNewswire

Dublin, Feb. 14, 2019 (GLOBE NEWSWIRE) -- The "Optical Coherence Tomography (OCT) - Global Market Outlook (2017-2026)" report has been added to ...

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Saving sight without surgery: Macular holes  WFTV Orlando

BACKGROUND: A macular hole is a small break in the macula, the center of the eye's light-sensitive tissue called the retina.

Epiretinal membrane: optical coherence tomography-based diagnosis and | OPTH  Dove Medical Press

Epiretinal membrane: optical coherence tomography-based diagnosis and classification William Stevenson, Claudia M Prospero Ponce, Daniel R Agarwal, ...

Consider operating early for ERM patients with good visual acuity  Healio

FORT LAUDERDALE, Fla. — Ophthalmologists may be delaying surgery for too long to treat epiretinal membranes in patients with good visual acuity, according ...

India- Optical Coherence Tomography Market Report to Grow at a CAGR of 11.7% by 2024 with Analysis by Type, Technology, Application, Size, Share, Growth Rate, End-User, Geography  MENAFN.COM

(MENAFN - GetNews) Global Optical Coherence Tomography Market, By Type (Catheter Based OCT Device, Doppler OCT Devices, Handheld OCT Devices, ...

Medication used to lower cholesterol levels may also protect eyes  Hindustan Times

Statin medication -- commonly used to lower cholesterol levels -- could also help prevent formation of scar tissue inside the eye, suggests a study. Retinal ...

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Macular hole is an eye condition that typically appears in people over the age of 60, but it is not the same as the much talked about eye disorder macular ...

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According to the report, global Retinal surgery devices market was valued around USD 1.4 billion in 2015 and is expected to generate revenue of USD 2.1 ...

Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy  Medscape

The best intraoperative peribulbar anesthetic during vitrectomy is ropivacaine (1%) compared with bupivacaine, lidocaine, and a solution of bupivacaine and ...

FDA Approves Gene Therapy for Inherited Blindness  Technology Networks

In a historic move, the U.S. Food and Drug Administration (FDA) today approved a gene therapy initially developed by researchers at the University of ...

Costs calculated for vitrectomy claims  Healio

SEATTLE — In patients with newly diagnosed macular hole, only 24% had a vitrectomy performed within 1 year, according to a poster presented here.

Statins may help prevent scar tissue in eyes  The Indian Express

Statin medication – commonly used to lower cholesterol levels – could also help prevent formation of scar tissue inside the eye, suggests a study. Advertising.

ERM significantly under-detected prior to cataract surgery  Healio

Epiretinal membrane was severely under-detected before cataract surgery, resulting in inflated reporting of the condition postoperatively, according to a large ...

High-tech 3D optical test free at BMC Eye Center  Manila Bulletin

Malolos City, Bulacan — The Bulacan Medical Center (BMC) Eye Center now offers optical coherence tomography (OCT) services, a non-invasive imaging test ...

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CORONADO, California — Changes in the retina might predict disease progress in patients with Parkinson's disease, according to a new study presented here ...

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Market Study Report, LLC, post a thorough analysis of the 'Retinal Pharmaceuticals market', has developed a comprehensive report emphasizing every vital ...

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Vital Art and Science Announces License Agreement with Genentech for Its mVT® Service  Business Wire

Vital Art and Science, LLC today announced that it has signed a license agreement with Genentech, a member of the Roche Group, for the use of Vital Ar.

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Learn more about the connection between nutrition and eye health from the California Optometric Association.

Exploring the link between thyroid hormones and vision loss - On Medicine  BMC Blogs Network

Age-related macular degeneration (AMD) is a major cause of vision loss in older people. Here, we speak to Layal Chaker and Robin Peeters, authors of a recent ...

Advances in Vitreoretinal Surgery  Medscape

Dr. Steve Charles takes you on a whirlwind tour of the latest developments in vitreoretinal surgery presented at AAO this year.

Vitreous Tamponades Market is Opportunity will Rise to US$89.9 mn by 2025

Transparency Market Research (TMR) in a new market study reports that the global vitreous tamponades market is highly fragmented with the presence of small ...

The proof a vitamin pill really CAN help you see better: TV's Dr Michael Mosley tried it himself  Daily Mail

After discovering some ground-breaking research at the Nutrition Research Centre Ireland, the team of Trust Me, I'm A Doctor decided to have a trial of their own, ...

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8 Very Soderberghian Things About The Knick  Vulture

At a time when cults form around top-to-bottom filmmakers like Quentin Tarantino and Christopher Nolan, Steven Soderbergh is in some ways a throwback to the ...

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“Latest Research Report On Retinal Pharmaceuticals Market: Retinal Pharmaceuticals is primarily used to treat retinal-related diseases. Retina is a layer of ...

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Vitreous Tamponades Market to attract a revenue of US$89.9 mn by the end of 2025  Cryptocurrency News

Global Vitreous Tamponades Market: Snapshot. A highly fragmented global vitreous tamponades market is distinctive in terms of dominance of a select number ...

Pucker Up: One French Kiss Swaps 80 Million Bacteria  Discover Magazine

When you kiss your significant other, you share a lot more than just an emotional bond — you transfer a significant load of oral microbes.

Volume 64 Number 18  UPENN Almanac

Welcome Back From the President. January 9, 2018; vol 64 issue 18; News; print. This is the alt text. Amy Gutmann. Celebrating Penn People. Welcome back ...

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Macular degeneration is a common eye disorder that occurs in old people. If not treated on time, it can lead to dire consequences such as complete loss of ...

Who is on the Late Late Show this week? Actress Victoria Smurfit, TV star Dermot Bannon and musician Glen  The Irish Sun

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Sabah Shah MD, MBA has Joined the Retina Group of New York Specializing in Uveitis and Vitreoretinal Surgery  PR Web

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JETREA®: The first Non-surgical treatment of Vitreo-Macular Adhesion  PR Web

The Retina Group of New York (RGONY) with offices in Hicksville and Hauppauge, NY, has announced the availability of JETREA® (Ocriplasmin), the first ...


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Recommended Macular Pucker Reading

Below are links to other helpful sites to read about macular pucker.

Dr. Pautler's Macular Pucker Blog