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


The Middlesboro Daily News

Handmade and homemade
The Middlesboro Daily News
Kuykendall often sews with one eye closed due to several eye issues she is battling such as a detached retina, myopic degeneration and macular pucker, to name a few. Despite her near-blindness, her disposition about her health issues and her passion ...


Medscape

Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy
Medscape
Indications for the surgery included proliferative diabetic retinopathy, vitreous hemorrhage, retinal detachment, retinal vein occlusion, macular degeneration, idiopathic macular hole, macular pucker, and high myopic maculopathy. Exclusion criteria ...


Healio

Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker
Healio
“The study was designed to develop quantitative measures of vision in patients with macular pucker. Right now, we only have visual acuity, and that's limited in its ability to really give us a handle on the degree of impact that macular pucker has on ...


Bel Marra Health

Macular hole causes, symptoms, treatments, and difference from macular degeneration
Bel Marra Health
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 degeneration. It's important to understand what makes them different, especially if you have a ...


Everyday Health (blog)

Dangerous Eye Problems You Should Never Ignore
Everyday Health (blog)
According to the National Eye Institute, some macular holes seal themselves, but surgery may be necessary to improve vision. A macular pucker is the formation of semitransparent scar tissue on the surface of the retina. Over time, the scar tissue can ...

and more »

NBC New York

I-Team: New York Workers' Comp Website Still Riddled With Errors
NBC New York
... an eye surgeon on the New York Workers' Compensation health provider search website. Akturk, who injured his eye after falling off a ladder, said he combed the state's website, but no ophthalmologist would agree to perform the macular pucker ...


Nature.com

The kinetics of VEGF and MCP-1 in the second vitrectomy cases with proliferative diabetic retinopathy
Nature.com
Twenty-one eyes of 21 patients who needed a second surgery for PDR were included. The reasons for the second surgery were tractional retinal detachment (TRD), neovascular glaucoma, persistent vitreous hemorrhage, macular pucker, and secondary ...


PR Web (press release)

Sabah Shah MD, MBA has Joined the Retina Group of New York Specializing in Uveitis and Vitreoretinal Surgery
PR Web (press release)
During her training, Dr. Shah has published numerous papers on anti-VEGF medications including Avastin, Lucentis and Eylea, and procedures that are currently used by retina specialists such as retinal detachment repair and macular pucker surgery.

and more »

News-Medical.net

Retinal Break
News-Medical.net
The retina is made up of a sensory layer containing the photoreceptors, a middle layer containing several types of other nerve cells, and an innermost layer comprising the ganglion cells which receive the transmit the received impulses through the ...

and more »

Foundation Fighting Blindness Sponsors Presentation by Retina Specialist James M. Maisel, MD on Macular ...
PR Web (press release)
James Maisel, MD will present “Macular Degeneration and Hereditary Retinal Degeneration” for the Foundation Fighting Blindness, Long Island Chapter Speaking Series, on September, 2016, 1:30-3:00 pm at the Farmingdale Public Library. The presentation ...


Daily Mail

The proof a vitamin pill really CAN help you see better: TV's Dr Michael Mosley tried it himself
Daily Mail
Apparently these macular pigments are not just protective against damage, they also play a role in vision, helping us to see detail more clearly, for example. And, according to the researchers, their levels decrease as we get older. 'One important ...

and more »

Good visualization in retinal surgery can improve outcomes
ModernMedicine
The patient also had a significant macular pucker. After treating the inflammation topically, I thought removing the lens would be a simple case of dialing it into the anterior chamber. I did not anticipate using the endoscope. The lens mobilized ...


A Place for Mom Senior Living News and Trends (blog)

How Diet and Nutrition Are Keys to Healthy Eyes
A Place for Mom Senior Living News and Trends (blog)
By adding powerful antioxidants to your diet, you can greatly improve your health, especially for your eyes. Researchers have linked nutrients such as lutein, vitamin C, and zinc to reducing the risk of certain eye diseases, including macular ...


Vitreous Tamponades to Witness High Demand due to Increasing Incidence of Diabetic Retinopathy, reports TMR
Medgadget (blog)
The major factor driving the global vitreous tamponades market is the increasing incidence of retinal detachment, macular pucker, and other ophthalmic conditions. Vitreous tamponades are used for the treatment of several vitreoretinal disorders such as ...

and more »

WFTV Orlando

Saving sight without surgery: Macular holes
WFTV Orlando
... on the retina and lead to a macular hole. Macular holes can also occur in other eye disorders, such as injury to the eye, retinal detachment, high myopia, and rarely, macular pucker. (Source: http://www.nei.nih.gov/health/macularhole/macularhole.asp).


OSLI Retina: Endoscopy remains a valuable tool for vitreoretinal surgery
Healio
That said, the endoscope remains a helpful tool to assist in vitreoretinal surgery, just as internal limiting membrane forceps are useful for membrane peeling in macular pucker and macular hole cases. The two classic indications for use of an endoscope ...

and more »

The Cannabist

Update: Colorado considers allowing medical pot use on probation, parole
The Cannabist
They included Christyne Smiley of Boulder, who is on probation and not allowed to use marijuana to treat an eye condition called a “macular pucker.” Instead she has to use prescription drugs she considers less effective. “Honestly, marijuana works ...

and more »

PR Web (press release)

JETREA®: The first Non-surgical treatment of Vitreo-Macular Adhesion
PR Web (press release)
In more severe cases, VMA causes a wrinkle in the retina called a macular pucker or tears the retina leading to a macular hole leaving a small central area blind spot. Until now, VMA required vitreous surgery at an ambulatory surgical center with ...

and more »

Daily Mail

The new jab that could stop YOU going blind: Cell-replacement therapy may halt a common cause of blindness
Daily Mail
Scientists have developed the first possible therapy for the most common cause of blindness in over-50s — dry age-related macular degeneration (AMD). The condition causes blind spots and blurry vision and can lead to sight loss. In a new study in ...

and more »

Daily Mail

How one woman's obsession with spinach and kale smoothies almost caused her to go BLIND after a build-up of a ...
Daily Mail
These were found to be caused by crystalised deposits in her macula - the delicate spot near the centre of the retina that is responsible for vision. Age-related macular degeneration - the leading cause of blindness in the world - is known to be ...


Smithsonian

These Blind Mice Just Got a Vision Boost Thanks to a New Transplant Technique. Could Blind Humans Be Next?
Smithsonian
The two most common kinds of retina disorders are retinitis pigmentosa and macular degeneration, which together affect about more than 20 million Americans. In both, a person experiences the world gradually shrinking and darkening before them as they ...

and more »

Daily Mail

End of monthly misery of injections for sight loss sufferers? New jab is needed just 5 TIMES year
Daily Mail
Older people at risk of blindness have hopes of an end to the misery of monthly injections to save their sight. More than 600,000 people in Britain have age-related macular degeneration, known as the 'Alzheimer's of the eye' because it robs elderly ...

and more »

Advances in Vitreoretinal Surgery
Medscape
We can all see that these will be used in selected cases, most probably macular surgery. They will be useful in other retinal detachment cases as well. To perform a vitrectomy, we need optimal visualization. Masahito Ohji from Japangave a brilliant ...


Daily Mail

Carrots? No, it's grapes that are great for your eyes - and could reduce the risk of blindness later in life
Daily Mail
Elevated oxidative stress is strongly associated with retinal disease and has been widely studied in the development of age-related macular degeneration and other eye conditions. In the study, mice were fed either freeze-dried whole grape powder – the ...

and more »

Daily Mail

'I tried various diets and slimming pills - but healthy eating took off the weight': The Real Marigold Hotel star ...
Daily Mail
Yes. But I don't much like exercising. I'd never join a gym, but I walk and am generally active. My fitness regimen is doing exercises for my back every morning while my porridge is cooking. GET YOUR FIVE A DAY? Sometimes more. I eat lots of fruit and ...


Daily Mail

Timelessly elegant at 100: Gone With The Wind's Olivia de Havilland celebrates milestone birthday and finally breaks ...
Daily Mail
Gone With The Wind's Olivia de Havilland, who turns 100 on Friday, has finally broken her silence on Hollywood's most famous sibling rivalry. The actress is one of the last living remnants of Hollywood's Golden Age and has now disclosed her true ...

and more »

Vulture

8 Very Soderberghian Things About The Knick
Vulture
Even the first of Soderbergh's two Spalding Gray films, Gray's Anatomy (1996), in which Gray recalls his worldwide journeys to treat an ocular condition known as a macular pucker, includes a lengthy segment on quack medicine. In episode six, Dr ...


PR Web (press release)

Retina Group of New York Now Offers Long-lasting Iluvien® Treatment for Diabetic Macular Edema
PR Web (press release)
The group provides eye care for patients with retinal problems such as diabetic retinopathy, macular degeneration, retinal vascular disease, retinal detachments, macular pucker, macula holes, surgical complications, uveitis and second opinions. Members ...

and more »

Daily Mail

The 'life-changing' glasses helping blind people to 'see': OrCam headset recognises faces, objects and reads words ...
Daily Mail
He said: 'Age-related macular degeneration is one of the most common causes of blindness in the elderly and it has no cure in its advanced stages. 'This device offers hope to patients who are beyond medical or surgical therapy for the condition.' 'It ...

and more »

Intravitreal cilium associated with retinal detachment 40 years following penetrating eye injury: a case report
BMC Blogs Network
Ophthalmic history included a penetrating injury of the right eye with a sharp metallic object 40 years ago and an uncomplicated phacoemulsification surgery in the same eye 2 years earlier. Fundoscopy revealed an inferior macula off rhegmatogenous ...

and more »
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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