What is the macula?
The macula is the part of the retina or nerve tissue in the back of the eye that is responsible for our central fine vision. It is what allows us to see and decipher words on the page of a book or to make out the details on something smaller or a longer distance away.
What is a macular pucker and how can it affect my vision?
A macular pucker (epiretinal membrane) is a growth of clear tissue over the macula. Many of these membranes are found on examination and do not produce any problems in asymptomatic patients. Some epiretinal membranes can contract on the surface of the macula, causing distortion in the retina and adversely affecting central vision.
What is a macular hole and how does it affect my vision?
A macular hole is a partial (lamellar) or full thickness loss of tissue in the central retina. It can lead to a progressive and permanent loss of a patient's central vision, ultimately leading to a central black area blocking sight.
What are the causes of macular pucker or hole?
The shrinkage of the vitreous or its separation from the retina as it shrinks can leave behind a membrane or can cause traction on the macula and create a hole. There are many factors that can increase the likelihood of this occurrence. They include:
- Inflammatory conditions
- Retinal vein occlusions
- Retinal tear or detachment
- Previous eye surgery
What are the symptoms of macular pucker and hole?
Common symptoms include blurred version, distorted or wavy vision, central blurred or black spot missing in vision or difficulty reading. An Amsler grid—a square consisting of vertical and horizontal lines resembling a checkerboard—may be used to monitor your central vision for changes resulting from a macular pucker or hole.
Both macular puckers and holes can be diagnosed by your eye care professional while he or she is performing a dilated retinal exam in conjunction with conducting other tests. You will then be sent to a retinal specialist for evaluation. He or she may recommend an Optical Coherence Tomography (OCT), a non-invasive test similar to an ultrasound designed to detect macular pucker or macular hole. Another testing option is called a Fluorescein Angiogram (FA), in which a special dye is injected into your arm and pictures are taken as the dye passes through the blood vessels in your retina. This allows your doctor to identify any leaking fluid in the retina caused by a macular pucker or hole.
Treatment of macular puckers and holes is indicated for symptomatic loss of vision. The treatment involves an outpatient vitrectomy surgery in which the vitreous and membranous traction is relieved through three microscopic openings in the sclera (the white part of the eye). The surgeon may use certain medications or dyes to help visualize the traction, while peeling membranes off the macula using microscopic instruments. At the end of the procedure, the surgeon may leave the eye filled with saline or a gas bubble. The latter, used for most macular holes and a few macular puckers, applies pressure to the edges of the macular hole, facilitating the healing process.
If a gas bubble is used, your doctor is likely to ask you to lie still with your head properly positioned for at least several days to ensure that the bubble stays in the correct position in the eye. Flying or traveling to high altitudes is contraindicated while the bubble is present; the gas can expand in the event of pressure changes and cause serious damage. The bubble will dissipate within the eye in a month or two.
A vitrectomy carries with it certain risks, although the likelihood is small. Those include:
- Retinal Detachment
- Permanent loss of vision
- Recurrent macular pucker or hole
Please discuss the risks and benefits thoroughly with your doctor before the surgery.
The FDA has approved an intraocular injection called ocriplasmin (Jetrea®) for the treatment of both full thickness macular holes and vitreomacular traction. This medication has limited success rates and is not indicated for every patient with a macular hole or pucker. Your surgeon can determine if you are a candidate for a trial of this or any other medication, prior to surgical repair.
What if I have other questions about macular pucker or hole?
Please contact one of the RGW offices and schedule a visit. Any of our retina-macula specialists will be more than happy to examine your eyes. And as always, the sooner you report visual symptoms to your doctor, the more likely he or she will be able to provide treatment to improve your vision.
Directions for Use(Under a good light source/wearing reading glasses if any)
- Hold the grid approximately one foot from your face and cover one eye.
- Using the other eye, look directly at the center dot on the grid.
- Notice if any of the straight lines appear wavy or distorted, or if there are dark or blurred sections of the grid. Use this as a baseline.
- Repeat with your other eye.
- If you notice new blurry, dark or distorted sections, contact your eye doctor immediately.