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


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 »

WABI

Healthy Start- Macular Pucker
WABI
Sometimes macular pucker is the result of an injury or a medical condition, such as diabetes, that affects the eye. Epiretinal membranes can sometimes form after eye surgery, including cataract surgery. The cause of most cases of macular pucker is not ...


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 ...


DIAGNOS Appoints New Director-Dr. Netan Choudhry
Marketwired (press release)
Dr. Choudhry has also received research grants to investigate: Diabetic retinopathy, Age-Related Macular Degeneration, Macular holes/puckers and uncommon conditions such as Retinitis Pigmentosa and Macular telegiectasia. "On behalf of my fellow board ...

and more »

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 »

Barlavento Online

Hospital Particular do Algarve realiza a primeira Vitrectomia
Barlavento Online
... surge associado a várias situações, sendo as mais vulgares, por exemplo, o tratamento de doenças retinianas, descolamento da retina, vitrerretina proliferativa, pucker macular (tecido fibroso na mácula, zona central da retina), buraco macular ...


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 ...


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 »

Accomplished Ophthalmologist, Peter H. Judson, MD is to be Featured in The Leading Physicians of the World
PR NewsChannel (press release)
He sees referrals for macular degeneration, diabetic retinopathy, retinal vein occlusions, retinal detachment, macular hole and macular pucker. Dr. Judson was educated at Dartmouth College, Weill Cornell Medicine – Cornell University medical school and ...


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 ...


Foundation Fighting Blindness Sponsors Presentation by Retina Specialist James M. Maisel, M.D. 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 ...


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 ...


Daily Mail

Sisters with eye disease macular dystrophy fear this is the last Christmas they can see
Daily Mail
The twins, who live together in East Grinstead, West Sussex, have been severely partially sighted with macular dystrophy since the age of seven, which causes a gradual loss of vision. Years later, they were also diagnosed with nystagmus - a condition ...


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).


The Cannabist

Colorado may allow medical marijuana use during 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 »

Medgadget (blog)

Retinal Surgery Devices Market Is Expected To Generate Revenue of USD 2.1 Billion By End of 2021
Medgadget (blog)
Various type of retinal surgery devices such as retinal laser equipment, microscopic illumination equipment, vitrectomy packs, vitrectomy machines, surgical instruments and others are used for the treatment of retinal diseases such as macula pucker ...

and more »

Nanotechnology for Retina promises Prosthetic Potential
Health Aim
Macular degeneration, retinitis pigmentosa, macular puckers, and macular holes are some examples of retinal diseases that can significantly affect vision and can sometimes be serious enough to cause blindness. The retina, a light-sensitive layer of ...


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 »

Daily Mail

Walnuts keeps heart disease at bay through lower cholesterol without weight gain
Daily Mail
A handful of walnuts a day could keep heart disease and other age-related illnesses at bay. Research has shown that regularly snacking on the nuts cuts artery-clogging cholesterol. Walnuts may also cut hunger pangs and reduce the odds of metabolic ...

and more »

Daily Mail

STATINS found to clear away deposits that cause blindness in the elderly
Daily Mail
An estimated 20 million people worldwide suffer with dry age-related macular degeneration - known as dry AMD - a disease which causes blurred vision and eventually blindness. Known as the 'Alzheimer's of the eye' because of the way it robs elderly ...

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 »

Daily Mail

Cure for blindness is in sight after British treatment produced astonishing results
Daily Mail
But the technique, which was developed with NHS funding, is being adapted to treat other conditions, including age-related macular degeneration. This affects 300,000 people and is the most common form of blindness in the elderly. Robert MacLaren, the ...

and more »

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 »

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 »

Retinal Surgery Devices Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2014 - 2020
PR Newswire (press release)
Retinal surgery devices are rapidly gaining popularity in the global market due to their wide array of applications in the treatment and management of various retinal diseases such as diabetic retinopathy, macular hole and macula pucker. Retinal ...

and more »

Daily Mail

Cause of blindness in elderly could be cured by anti-depressants 'already on sale'
Daily Mail
Millions of people could be prevented from going blind by drugs designed to treat depression and strengthen bones, research suggests. In tests on mice, drugs already on sale for other conditions prevented the first stage of age-related macular ...


Daily Mail

Gone With The Wind's Olivia de Havilland breaks silence on sibling rivalry as she turns 100
Daily Mail
The actress is one of the last living remnants of Hollywood's Golden Age and has now disclosed her true feelings about her late sister Joan Fontaine, revealing that she calls her 'Dragon Lady.' Posing on a chaise longue in a demure black dress in her ...

and more »

Tuscola Today (subscription)

CIALIS ONLINE - Order Synthetic Viagra
Tuscola Today (subscription)
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. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, ...

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