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


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 ...


About the Retina Group of New York
Benzinga
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macula pucker, macula hole, cataract surgery complications, uveitis, Plaquenil toxicity and second opinions. The group, led by CEO and ...

and more »

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 ...


FOUNDATION FIGHTING BLINDNESS
Benzinga
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macula pucker, macula hole, cataract surgery complications, uveitis, Plaquenil toxicity and second opinions. As dedicated Board Certified ...


NewsMaker (press release)

Retinal Surgery Devices Market will hit USD 2.1 billion by 2021
NewsMaker (press release)
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 ...


5 retailers fined $14200 for unlicensed sale of shisha tobacco
AsiaOne
Five retailers in Kampong Glam were fined a total of $14,200 after they were found guilty of selling shisha molasses/tobacco without licence, the Health Sciences Authority (HSA) said on Friday (Sept 16). Four of the retail outlets had persisted in the ...

and more »

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 »

Global Vitreous Tamponades Market is Expected to Reach USD 77.5 Million Globally in 2020; Driven by High ...
GlobeNewswire (press release)
Increasing incidence of macular pucker, diabetic retinopathy, and other retinal disorders that require attentive care of the retina during the course of treatment is fueling the vitreous tamponades market. In addition, the increasing number of ...


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 ...


Efficacy of vitrectomy and epiretinal membrane peeling in eyes with dry age-related macular degeneration
Dove Medical Press
Conclusion: ERM peeling in eyes with dry AMD may show significant improvement, especially in eyes with good preoperative BCVA. The procedure is relatively safe with low complications and reoccurrences. Keywords: macular pucker, epiretinal membrane ...


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 ...


New Macon Eye Care Practice Focusing on Providing Quality Care
Georgia Informer
Yee has a broad range of clinical interests within retinal disease and surgery, including management of complex retinal detachments, macular degeneration, diabetic retinopathy, as well as macula pucker surgery. Miller is a Middle Georgia native that ...


Optical Coherence Tomography (OCT) Market Projection On New Trends and Technical Advancement
Medgadget (blog)
This huge geriatric population would also face various ophthalmologic complications such as diabetic retinopathy and age-related macular degeneration, amongst other. However, owing to the economic development and high awareness rate, other regions ...


WFTV Orlando

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. The macula is responsible for providing the central vision we need for seeing fine detail, like reading, or driving. A macular ...


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 ...


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 »

Medgadget (blog)

Technological Innovations for Improved Surgical Accuracy Instrumental for Growth of Global Retinal Surgery Devices ...
Medgadget (blog)
This is because age is a major factor that increases the chances of ocular diseases, of which, diabetic retinopathy, macular pucker, and retinal detachment are most common. As per estimates of the World Health Organization (WHO), the global geriatric ...

and more »

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

Grapes are great for your eyes and could reduce 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 »

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

Eye implant which could stop 700000 people going blind now available on the NHS
Daily Mail
It will offer hope to the hundreds of thousands of people with age-related macular degeneration (AMD) - the leading cause of sight loss in the over-55s. The disease gradually robs people of their central vision, and about four million Britons have it ...


ChesterChronicle.co.uk

Farndon woman whose sight was saved by eye test urges others to look after their vision
ChesterChronicle.co.uk
Unfortunately, Claire was one of the 20% of cases where the procedure does not heal as planned but results in a macular pucker. “It was just bad luck,” adds Claire. “My vision was wiggly, as the macular had not healed smoothly over the retina. I had to ...


Daily Mail

Sautéing vegetables in olive oil 'increases antioxidants'
Daily Mail
Budding chefs eager to cook up healthy meals for friends and family face a barrage of conflicting advice. There are advocates of the raw food diet, who abhor the thought of cooking. And then there are those who believe black pudding to be the latest ...


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 »

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 »

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 »

Daily Mail

Could a stem cell jab stop your eyesight from failing? We look at some of the treatments being tested in Britain
Daily Mail
More than half a million people in Britain have age-related macular degeneration (AMD) - damage to the macula, the area at the back of the eye that helps us pick out visual details. Nine out of ten cases are dry AMD, where the macula is damaged by a ...

and more »

Daily Mail

Moorfields Eye Hospital pairs with Google's DeepMind to prevent blindness
Daily Mail
'Our research with DeepMind has the potential to revolutionise the way professionals carry out eye tests and could lead to earlier detection and treatment of common eye diseases such as age-related macular degeneration,' Professor Sir Peng Tee Khaw, ...
Revealed: Google AI has access to huge haul of NHS patient dataNew Scientist
DeepMind Health – Moorfields Eye Hospital London Collaboration - YouTubeYouTube
Research | DeepMindDeepMind
Moorfields Eye Hospital -The Guardian
all 104 news articles »

Colorado Springs Gazette

Colorado moving to allow marijuana use by people on probation
Colorado Springs Gazette
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 »

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 ...

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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