The eye consists of different parts, including the cornea, retina and iris. The light sensitive retina is located at the back of the eye, functioning to transmit electrical messages to the optic nerve, which is also situated to the rear of the eye. The macular is positioned in the centre of the retina and functions to give us direct detailed central vision. When scar tissue develops on the macular part of the eye, known as a macular pucker, fibrosis of the macular, epiretinal membrane, cellophane maculopathy, premacular fibrosis, preretinal membrane, surface wrinkling retinopathy, retina wrinkle or internal limiting membrane disease, it obstructs vision so that what is seen appears blurred or without sufficient detail.
How does Macular Pucker happen?
Shrinking of the Vitreous
The inside of our eyes, making it round, are a complex network of fine fibres within gel-like vitreous. Over time through ageing the vitreous shrinks, receding from the retinal surface until it detaches from the retina. This is quite commonly described as floaters and occurs in many cases without damaging effects. Little specks or dots may be visible in the line of sight and will move as the eye moves.
Retinal detachment and scar tissue
If, when the vitreous detaches from the retina its surface is damaged, the retina will compensate through self-healing causing scar tissue to form. As the scar tissue contracts the retina contracts and wrinkles too. As long as the scar tissue hasn't formed over the macular in the centre of the retina, the central vision will remain intact and normal. If the scar tissue does cover the Macular, however, then the contracted wrinkles will “pucker” and distort central vision so that the person affected cannot see properly.
Are there other causes of Macular Pucker?
Yes, Macular Pucker can also result from:
- Eye injury or damage to the retina.
- Uveitis (irritation of the eye).
- Medical conditions and diseases, such as diabetes leading to diabetic retinopathy.
- Eye disorders and diseases, such as damaging retinal detachment.
Are there other related Macular conditions?
There are two other conditions affecting the macular:
- Macular degeneration: Wet when blood vessels grow abnormally under the macular and dry when macular cells break up.
- Macular hole: a torn, not wrinkled, macular due to retinal detachment
Both conditions affect the visual field, but are not the same as macular pucker.
How is Macular Pucker diagnosed?
An eye doctor, such as an Ophthalmologist, will examine the eyes to see if scar tissue is present and where it is located. Optic testing is used for diagnosis and to gauge the extent of visual distortion due to macular pucker. The condition may occur in one or both eyes and may or may not become worse, depending on the health of the eyes and overall health.
How does Macular Pucker affect sufferers?
People experiencing macular pucker will have vision loss in varying degrees. Their vision may be blurry without proper detail and sight will appear distorted and wavy instead of straight. Normal activities like reading, looking at street names, watching television, recognising people and driving may become difficult. Blind spots may be present in the visual field so that certain details are entirely missed.
Is Macular Pucker treatable and curable?
Macular pucker may be so mild that no treatment is required. Therapies such as supplements, medications and eye drops cannot correct macular pucker. If the scar tissue becomes separate from the retina away from the macular, then macular pucker may naturally correct itself. However, in cases of more severe visual distortion affecting daily activities, surgery may be necessary.
Vitrectomy surgery is used to remove scar tissue covering the macular and replace the vitreous gel-substance within the eye with salt solution that is quite safe and effective. Eye drops are provided with medication to prevent infection. A qualified eye doctor will identify if you are a good candidate for vitrectomy surgery based on the severity of your macular pucker. The operation is performed under local anaesthetic and requires the wearing of a protective eye patch during recovery.
What are the risks associated with treatment for Macular Pucker?
Vitrectomy Surgery, like any other, poses risks. However, two main concerns are the increased likelihood of cataracts developing and that the scar tissue may grow back over the macular. Patients are monitored for further treatment if necessary.
Is it beneficial to have Macular Pucker treatment?
If macular pucker is distorting central vision so much that daily activities are limited as a result, surgery is a viable option to restore vision closer to normal so that life can be enjoyed with better health.
Can Macular Pucker be prevented?
When looking at the causes of macular pucker, we can see that ageing can lead to damaging retinal detachment, and ageing cannot be prevented. However, we can try and protect our eyes against damage, such as protectors worn by people soldering as part of their work. Seeking treatment early for eye infections, inflammations and illnesses affecting the eyes can prevent further damage to the eye. If in doubt about your eyes always consult a doctor who can refer you to an eye specialist.