Macular Pucker: symptoms, cause, prevention, treatments, risks, complications, long-term outlook

What is a Macular Pucker?

A macular pucker is scar tissue that has formed on the eye's macula. The macula is located in the center of the eye's light-sensitive tissue called the retina.

A macular pucker is also called epiretinal membrane, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.

What is the Function of the Macula?

The main function of the macula is to provide sharp, central vision. Sharp, central vision is needed for reading, driving, and seeing fine detail. A macular pucker can cause blurred and distorted central vision.

Vitreous Detachment?

Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects, except for a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.

However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina's surface. When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina surface. When the scar tissue contracts, it causes the retina to wrinkle, or pucker, usually without any effect on central vision. However, if the scar tissue has formed over the macula, our sharp, central vision becomes blurred and distorted.

What causes a Macular Pucker?

Most macular puckers are related to vitreous detachment. Vitreous detachment usually occurs in people over age 50. As you age, you are at increased risk for macular pucker.

A macular pucker can also be triggered by certain eye diseases and disorders, such as a detached retina and inflammation of the eye. Also, people with diabetes sometimes develop an eye disease called diabetic retinopathy, which can cause a macular pucker. A macular pucker can also be caused by trauma from either surgery or an eye injury.

What are the symptoms of a macular pucker?

The most common symptom of a macular pucker is vision loss. Vision loss from a macular pucker can vary from no loss to severe loss. Severe vision loss is uncommon. Blurry vision, mildly distorted, and straight lines that appear wavy are also common symptoms. The individual may also have difficulty in seeing fine detail and reading small print. There may be a gray area in the center of your vision, or perhaps even a blind spot.

Is a Macular Pucker the same as Age-Related Macular Degeneration?

No. A macular pucker and age-related macular degeneration are two separate and distinct conditions.

Can a Macular Pucker get Worse?

For most people, vision remains stable and does not get progressively worse. Usually macular pucker affects one eye, although it may affect the other eye later.

Is a Macular Pucker Similar to a Macular Hole?

A macular pucker and a macular hole are different conditions, although they both result from the same reason: The pulling on the retina from a shrinking vitreous. When the "pulling" causes microscopic damage, the retina can heal itself; scar tissue, or a macular pucker, can be the result. If the shrinking vitreous pulls too hard, it can tear the retina, creating a macular hole, which is more serious.

A macular pucker will not "develop" into a macular hole.

How is a Macular pucker treated?

A macular pucker usually requires no treatment. In many cases, the symptoms of vision distortion and blurriness are mild, and no treatment is necessary. People usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker.

Rarely, vision deteriorates to the point where it affects daily routine activities. However, when this happens, surgery may be recommended.