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


Global Optical Coherence Tomography Market Analysis, Size, Regional Outlook, Competitive Strategies and Forecasts ...
satPRnews (press release)
On the basis of 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.

and more »

NBCNews.com

Robot Performs First-Ever Surgery Inside Human Eye
NBCNews.com
... the macula, a region near the center of the retina that sharply focuses images, a crucial process for reading or seeing fine detail. When membranes form here, a person's central vision becomes blurred and distorted, in a condition called a macular ...

and more »

Merkur.de

Wiesn-Wirt Steinberg nach OP auf einem Auge blind
Merkur.de
Zusätzlich kann sich im Alter ein dünnes Häutchen auf der Netzhaut bilden, auch „Macular Pucker“ genannt. Wenn diese Membran Falten wirft, kann es zu unscharfem Sehen kommen. Eine operative Entfernung ist die gängigste Behandlungsmethode und ...

and more »

ABC Action News

Solar eclipse: Eye damage can show later
ABC Action News
You may start noticing blurry or distorted vision in the center of the eye. In severe cases, you can end up losing vision completely in the middle. If that happens, it means you may have a macular hole or macular pucker. "You would not want to live ...

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 ...


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 »

AARP News

Serious Eye Condition Being Misdiagnosed?
AARP News
A new JAMA Ophthalmology study found that one in every four cases of age-related macular degeneration (AMD) was missed by trained eye care professionals, a finding that could have serious implications for the growing population of older adults most at ...

and more »

Optician Online

Case study: A traumatic case - part 3
Optician Online
There is no evidence of the posterior hyaloid within the vitreous cavity, implying a complete posterior vitreous detachment (PVD). The other possibility is a spontaneously resolved epiretinal membrane (ERM). The macular pucker and scalloped pattern to ...


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 ...


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)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macular pucker, macula hole, surgery complications, uveitis, Plaquenil toxicity, retinal degenerations and second opinions. For more ...

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 »

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)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macular pucker, macula hole, surgery complications, uveitis, Plaquenil toxicity and second opinions. For more information on The Retina Group ...

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 »

PR Web (press release)

American Diabetes Association to Offer No-Cost Health Screenings and Resources for New Yorkers Living with ...
PR Web (press release)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macular pucker, macula hole, surgery complications, uveitis, Plaquenil toxicity and second opinions. For more information on The Retina Group ...

and more »

Retina Group of New York Chairman James M. Maisel, MD Chairs Diabetes Epidemiology, Prevention, Care and ...
PR Web (press release)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macular pucker, macula hole, surgery complications, uveitis, Plaquenil toxicity and second opinions. For more information on The Retina Group ...

and more »

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 »

LaSalle News Tribune

5 Things to Know About Floaters in the Eye
LaSalle News Tribune
Bleeding in the eye is not apparent on the outside, but can cause a “smoke screen” effect as well as floaters, and is typically due to diabetes, macular degeneration, retinal tears and other eye injuries, Dr. Kishore noted. As for PVD, this is when the ...


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 ...


Daily Mail

New therapy for macular degeneration shows promise: study
Daily Mail
An experimental treatment may significantly slow the progression of the blindness-causing disorder macular degeneration, in what would mark the first therapy of its kind, research showed Wednesday. There are currently no available treatments to stymie ...

and more »

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 »

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

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 »

Daily Mail

Tiny telescope inserted into your eye that 10 TIMES stronger than glasses: Implant for poor vision helps treat age ...
Daily Mail
Print in newspapers and books became blurred and after a few months of this, I went to my optician who said I was very likely to be suffering from the early stages of age-related macular degeneration (AMD). Both my eyes were affected, though my right ...


Daily Mail

EXCLUSIVE: Tragedy of twin sisters, 6, BOTH diagnosed with rare terminal disease that will trigger seizures, rob ...
Daily Mail
Sad: Both Amelia (left) and Makenzie were diagnosed with macular dystrophy - vision loss that affects the retina - around the age of six. Amelia got her Batten disease diagnosis two days later. Now, aged seven, Makenzie is exhibiting similar symptoms ...


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).


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 ...


BMC Blogs Network (blog)

Exploring the link between thyroid hormones and vision loss
BMC Blogs Network (blog)
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 study published in BMC Medicine, about why thyroid function and AMD may be linked, and the ...


Daily Mail

The twins who are both going BLIND: Sisters suffering from rare eye disease fear this will be the last Christmas ...
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 ...

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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