What does a retinal pucker mean?

An uncommon eye problem called a macular pucker can make your vision wavy or blurry. Most of the time, there is no clear cause. 

A lot of people with macular pucker have mild symptoms, and most of them don’t need any kind of treatment. You may need surgery to help you see better if a macular pucker makes it hard for you to do everyday things.

How often does retinal pucker happen?

New studies say that between 18.8% and 34.1% of Americans have macular pucker. The risk goes up with age. Luckily, most of these people don’t end up losing their sight.

Symptoms

How do you know if you have a retinal pucker?

Central vision problems are the main sign of macular pucker. It looks like straight lines are wavy. Metamorphopsia is another word for this kind of blurred vision.

A macular pucker can happen in either eye, but it happens in only one eye most of the time. One eye will likely be worse if you have it in both.

Along with seeing distorted lines, you may not be able to see as clearly as you used to, even if you are close to what you’re looking at. The image in one eye may also seem bigger than the image in the other eye. It’s important to note that glasses can’t fix the vision impairment that macular pucker causes.

Causes of Macular Puckers

There is no clear reason why some people get macular pucker and others don’t. This is called an “idiopathic” macular pucker. Having said that, the following are common situations in which macular pucker shows up:

• PreviousVitreous Detachment 
• Middle Age
• Previous Eye Inflammation or Uveitis
• Retinal problems in the past, like surgery for retinal detachment
• Previous Laser  surgery

Macular pucker is most often caused by getting older. The vitreous starts to get smaller and pulls away from the retina as life goes on. Most of the time, it pulls away from the retina and macula without any issues. But, the gel can stick to the retina and/or the macula occasionally. If it sticks, scar tissue can form, which can make the retina and macula wrinkle or pucker.

Epiretinal Membranes and Macular Puckers

Epiretinal membranes are also called cellophane maculopathy or macular puckers. Epiretinal Membranes (ERMs) are fibrocellular membranes that can form on the inner surface of the retina. They are avascular, which means they don’t have many or any blood vessels. They usually don’t cause any symptoms and can just be seen, but sometimes they can cause mild vision loss and metamorphosis (wavy or distorted vision) which is a change in how you see things. ERMs usually cause the most noticeable symptoms when they affect the macula. The macula is the center part of the retina that helps us see small details, which is needed for reading and recognizing faces.

Macular Pucker Diagnosis and Monitoring

An ophthalmologist can tell if someone has a macular pucker by looking at the retina after using drops to make the pupils bigger. Over time, its growth can be tracked by measuring visual acuity or looking at a graph called an Amsler grid to see if the person’s vision is blurred. Some of these are color pictures of the retinas and important cross-section pictures of the retinas made with a method called optical coherence tomography (OCT). The OCT shows how much scar tissue has formed on the retina and how the retina has been distorted by the scar tissue pulling on it.

Treatment Options for Macular Puckers

Surgery is the only known way to treat it. If the retinal pucker isn’t too bad and your vision is good, you should probably just watch it. On the other hand, surgery might help if the pucker has made it hard to see clearly. During the surgery, a vitrectomy, some of the vitreous gel is taken out, and the abnormal membrane on the retina’s surface that is causing the wrinkle or pucker is peeled off. Usually, the surgery doesn’t take more than an hour, and it can be done as an outpatient treatment with either local or general anesthesia. After surgery, the eye is usually only slightly sore, and patients can go back to normal within a few days.

Benefits of Macular Pucker Surgery

In the weeks to months after surgery, most people will gradually notice some improvement in their vision, such as clearer vision or less blurring. It’s hard to say how much better the vision will be, and some people don’t get better even after the macular pucker is fixed. If you have a pretty “fresh” pucker, your vision will probably get better faster than if you have a very old pucker. A retinal pucker doesn’t usually grow back, but it can happen.

Surgery to fix a retinal pucker is optional, and there are risks with both the surgery itself and the sedation that is used.  Although issues are not common, if an eye problem like a retinal tear, hemorrhage, or infection happens, some amount of sight may be lost.  It is pretty normal for cataracts to form or get worse months after surgery.  People who choose to have surgery for a macular hole should know that they may need surgery for cataracts in the future.  Your surgeon will talk to you more about the risks, rewards, and other options of surgery. He or she will also make specific suggestions based on what they find in your exam.

Do You Need Macular Pucker Surgery?

Most of the time, treating retinal pucker is not necessary because the eye problem is not very bad. If the eyesight loss is more severe, though, surgery may be needed to fix it. Doctors use minimally invasive vitrectomy surgery to get rid of the vitreous gel. After the surgery, the scar tissue is peeled off. To your surprise, the scar tissue on the macula’s surface can be very tough. The underlying retina is often shaped by the long-term distortion caused by scar tissue. To help the retina relax even more, the internal limiting membrane may also be pulled off.

After surgery, most people need to use eye drops for two to three weeks. One problem that can happen with macular pucker surgery is that it has a 1% chance of tearing or detaching the retina, which would need more surgery to fix.

About 1 out of every 2,000 to 3,000 people will get an infection in their eye that needs drugs to treat. Having a vitrectomy makes cataracts grow earlier in life. This is likely because the surgery increases the flow of oxygen to the lens. After two weeks, the outside of the eye should look normal again, but it could take months for the vision to reach its full potential. The longer the scar tissue was there before surgery, the longer it takes for the vision to get better.

Most people who have surgery for macular pucker see better by about three lines. Your eye doctors will give you a fuller explanation of what to expect, any risks, and how to take your medicines after surgery.

Recovery After Macular Pucker Surgery

It takes about a week or two for your body to heal after surgery. We suggest that you take it easy for the first week. Do not lift anything bigger than a milk jug, bend your head below your heart, or rub or strain your eye. All of these things will raise the pressure in the eye, which could have very bad results. You can go back to work after the first week. You don’t have to sleep in a certain position for the first two weeks, and you can walk around. Most of the time, you can slowly start doing normal daily activities again after about two weeks.

Non-Surgical Treatment Options for Macular Puckers

Most patients only have mild symptoms, so new glasses, reading lamps, and maybe even magnifiers will help them the most. For people with more serious symptoms, medical or surgery care may be needed. Some people with a macular pucker that is caused by the vitreous pulling on the macula (vitreomacular traction) may see better after getting a single dose of a drug called Jetrea into the eye. This medicine is an enzyme that breaks down the vitreous’s tiny threads, which might free up the tension.

Frequently Asked Questions about Macular Puckers

What exactly is a macular pucker?

The problem could be a blur or a film over your view. The top layer of the retina gets scar tissue. As it grows older, it gets smaller, which could lead to more warping.

How did I get a macular pucker?

As for the reason, sometimes it is hard to determine. But it could be anything that caused inflammation in the eyes in the past. The reason could be old age, posterior vitreous detachments, retinal tears or detachments, Uveitis, or something else.

How do you treat a macular pucker?

The scar tissue can only be taken off by surgery.

Will I go blind if I don’t get macular pucker surgery?

No, you won’t go blind for good, but it can get bad enough to affect your vision or make you legally blind. It can also make you more likely to get a CNV early.

How quickly does macular pucker get worse?

Most of the time, macular puckers don’t change much. For most people, they form and affect their vision over the course of three months. After that, they rarely change. A macular pucker will appear in about 25% of people who already have one. Some tests have shown this to be true.

What is the new way to treat retinal pucker?

Some people with a macular pucker that is caused by the vitreous pulling on the macula (vitreomacular traction) may see better after getting a single dose of a drug called Jetrea into the eye. This medicine is an enzyme that breaks down the vitreous’s tiny threads, which might free up the tension.

When should you have surgery for a macular pucker?

A retinal hole can make it hard to read or drive, among other things. If this happens, you should see an eye doctor. It’s possible that you will need surgery to get rid of the membrane and make your retina smooth again.

Eye drops: Do they help with macular pucker?

People who have macular pucker can’t see better with eye drops, medicine, or laser surgery. But if you have any of the other conditions, your eye doctor may give you these treatments.

References

Macular Pucker – Retina Specialists of Mississippi. (2023, February 27). Retina Specialists of Mississippi. https://retinams.com/our-services/macular-pucker/

Macular Pucker. (2023, March 22). Retina Specialists. https://www.nycretina.com/conditions/macular-pucker/

Epiretinal Membranes  – Patients – The American Society of Retina Specialists. (n.d.). ASRS. https://www.asrs.org/patients/retinal-diseases/19/epiretinal-membranes

Macular Pucker | National Eye Institute. (n.d.). https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-pucker