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

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Do bloodwork numbers reflect minor cold or something more?
Sunbury Daily Item
DEAR DR. ROACH: I recently had a cataract removed in my left eye and lens-replacement surgery in both eyes. Upon completion and before the first two-week follow-up appointment, I noticed visual abnormalities — quite different in each eye — which were ...


Doc: Do bloodwork numbers reflect minor cold?
The Detroit News
Dear J.W.: Macular pucker, also called epiretinal membrane, is essentially a scar over the macula, the very center of the retina, where our vision is sharpest. It is not related to macular degeneration, and it probably had nothing to do with the ...

and more »

Vitreous Tamponades Market Progresses for Huge Profits of US$89.9 Mn During 2017-2025
Industry Today (press release)
The global market for vitreous tamponades is primarily driven by the increasing incidence of retinal detachment, diabetic retinopathy, macular pucker, and other retinal disorders. As per statistics of the International Diabetes Federation, around 300 ...

and more »

Retinal Drugs Market: Key Trends and Forecast Research Report
MilTech
Retina is a layer of nerve tissue lining the back of the eye. Retina receives light and convert it into neural signals, and send these signals to the brain for visual recognition. The central part of the retina is known as macula, which is responsible ...

and more »

Leading Vendors (Bausch & Lomb Incorporated, Johnson & Johnson , Roche Pharmaceutical, Essilor International SA ...
MilTech
Based on application, the market is segmented into age-related macular degeneration, central serous retinopathy, diabetic retinopathy, macular edema, macular hole, macular pucker, vitreomacular traction, pre-retinal membranes, others. On the basis of ...


Vitreous Tamponades Market to Observe Strong Development of US$ 89.9 Mn by 2025 End
MilTech
Transparency Market Research (TMR) in a new market study reports that the global vitreous tamponades market is highly fragmented with the presence of small and medium sized players. A distinct feature of the market is that each region is dominated by a ...

and more »

NBCNews.com

Robot Performs First-Ever Surgery Inside Human Eye
NBCNews.com
As people age, the vitreous slowly shrinks and pulls away from the retinal surface, sometimes tearing it. The membrane is essentially a scar on the retina. It can act like a film, obscuring clear vision, or it can distort the shape of the retina. The ...

and more »

Pamplin Media Group

Macular Regeneration Clinic a success in St. Helens
Pamplin Media Group
The program is appropriate for wet or dry macular degeneration, Stargardt Disease, retinitis pigmentosa, macular pucker (epiretinal membrane) and diabetic retinopathy. Other vision conditions including glaucoma, uveitis (iritis), conjunctivitis, and ...


Retinal Surgery Devices Market Expected to Reach USD 2.1 billion by 2021: Zion Market Research
GlobeNewswire (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 macular pucker ...

and more »

ABC Action News

Solar eclipse: Eye damage can show later
ABC Action News
If that happens, it means you may have a macular hole or macular pucker. "You would not want to live like that. That would be legally blind," said Dr. Perez. RELATED | What can you do with those eclipse glasses? He says if you are concerned you did ...

and more »

Medscape

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 lidocaine, according to a randomized, double-blinded trial published online February 7 in the ...


AARP News

Serious Eye Condition Being Misdiagnosed?
AARP News
“As the baby boomer population comes into the years when age-related macular degeneration becomes more prevalent, we need to make sure that patients are properly diagnosed,” says lead study author David Neely, M.D., of the University of Alabama ...

and more »

Vital Art and Science Announces License Agreement with Genentech for Its mVT® Service
Business Wire (press release)
The mVT® Service is currently commercially available to retina specialists for patients with maculopathy, including dry and wet age-related macular degeneration, diabetic retinopathy, diabetic macular edema, macular pucker, macular hole, retinal vein ...

and more »

Healio

Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker
Healio
Objective measures of contrast sensitivity and visual distortion can be used to assess the impact of macular pucker on visual function, according to a study. “The study was designed to develop quantitative measures of vision in patients with macular ...


Global Retinal Surgery Devices Market worth $2.1 billion by 2021: Zion Market Research
GlobeNewswire (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 ...

and more »

Everyday Health (blog)

Dangerous Eye Problems You Should Never Ignore
Everyday Health (blog)
“A macular hole is a small, full-thickness defect in the macula,” Grodin says. “You may notice loss of central vision or blurred or distorted central vision, making it difficult to read or drive. Macular holes most often result from aging and 'bad luck ...

and more »

ModernMedicine

Paradigm shifting for ILM peeling, prone position after vitrectomy
ModernMedicine
The intraoperative goal in patients with vitreoretinal diseases is restoration of the retinal anatomy by removing traction from the vitreous and the retinal surface in retinal detachment, vitreomacular traction, macular holes and puckers, and retinal ...


Retina Group of New York Chairman James M. Maisel, MD Chairs Diabetes Epidemiology, Prevention, Care and ...
PR Web (press release)
... of Medicine, North Shore University Hospital, and NuHealth Nassau University Medical Center. The practice is limited to medical and surgical retinal problems. These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion ...

and more »

Find Market Research By Abhishek Budholiya (press release) (blog)

Retinal Drugs Market – Technological breakthroughs, Value chain and stakeholder analysis by 2025
Find Market Research By Abhishek Budholiya (press release) (blog)
Retina is a layer of nerve tissue lining the back of the eye. Retina receives light and convert it into neural signals, and send these signals to the brain for visual recognition. The central part of the retina is known as macula, which is responsible ...

and more »

Vitreous Tamponades Market to Reach US $89.9 Million by the End of 2025: Transparency Market Research
Digital Journal
“Steady growth of vitreous tamponades market is witnessed due to increasing incidence of retinal detachments, diabetic retinopathy, macular pucker, and other retinal disorders,” explains the lead author of the study. As per statistics of the American ...

and more »

PR Web (press release)

Retina Group of New York to Exhibit at No-Cost Bellport Low Vision/Technology Fair for Visually Impaired
PR Web (press release)
James M. Maisel, MD, Chairman and Founder of Retina Group of New York, served on the American Academy of Ophthalmology Low Vision Committee and is a recognized expert in diagnosis and treatment of many of the leading causes of blindness including ...

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 ...


PR Web (press release)

Flatbush Community Health Expo and Diabetes Symposium Features Diabetic Retinopathy Education and Screening ...
PR Web (press release)
Retina Group of New York (RGONY) is pleased to be a sponsor, speak about “Diabetic Retinopathy Prevention, Detection and Treatment” and provide no-cost retinopathy screening at the Island of Flatbush Community Health Expo and Diabetes Symposium on ...

and more »

PR Web (press release)

Retina Group of New York to Provide Diabetic Retinopathy Education at Tour de Cure and Step Out Walk to Stop ...
PR Web (press release)
... cutting-edge diagnostic equipment, and integrated electronic records. The group holds staff privileges at eight area hospitals and teaching appointments at the Hofstra Northwell School of Medicine, North Shore University Hospital, and NuHealth ...

and more »

Optician Online

Case study: A traumatic case - part 3
Optician Online
The changes observed in the right eye are consistent with spontaneously resolved vitro-macular adhesion. There is no evidence of the posterior hyaloid within the vitreous cavity, implying a complete posterior vitreous detachment (PVD). The other ...


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 »

PR Web (press release)

American Diabetes Association to Offer No-Cost Health Screenings and Resources for New Yorkers Living with ...
PR Web (press release)
... cutting-edge diagnostic equipment, and integrated electronic records. The group holds staff privileges at eight area hospitals and teaching appointments at the Hofstra Northwell School of Medicine, North Shore University Hospital, and NuHealth ...

and more »

NBC New York

I-Team: New York Workers' Comp Website Still Riddled With Errors
NBC New York
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 surgery he needed to restore his vision. In March, the I-Team called more than 60 ...


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 ...


ZyDoc Chairman James M. Maisel, MD Chairs the Epidemiology and Prevention of Diabetes Section at the 5th World ...
PR Web (press release)
... cutting-edge diagnostic equipment, and integrated electronic records. The group holds staff privileges at eight area hospitals and teaching appointments at the Hofstra Northwell School of Medicine, North Shore University Hospital, and NuHealth ...

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