What is Macular Pucker?
Jacksonville, FL retina eye specialists, Dr. John Sullivan and Dr. Shawn Agee, are both trained to treated Macular Puckers of the retina. Scar tissue can form on the eye’s macula in a condition referred to as macular pucker or epiretinal membrane. The macula is located in the center of the retina, a layer of light-sensitive tissue located in the back of the eye. The macula is involved in visual acuity (sharpness) and central vision, which corresponds to activities like reading and driving. When macular pucker arises, the central vision becomes distorted and blurred, causing problems completing everyday activities. The scar tissue can develop as a result of other conditions where the retina has healed itself. While macular pucker usually affects only one eye, both eyes can experience the condition.
Causes and Symptoms
The cause of macular pucker has a large part to do with the anatomy of the eye. Inside of the eye is a gel called vitreous, which is located between the lens and the retina, and is responsible for the eye having a round shape. This gel is filled with millions of fibers that are connected to the surface of the retina, and over time, the vitreous shrinks. This causes the vitreous gel to disengage from the retinal surface. In turn, this can lead to retinal damage, which will initiate the healing process of the retina.
Through this healing process, scar tissue can develop and become firmly attached to the retina. A contraction of the scar tissue can cause the retina to pucker, or wrinkle. Other times, the scar tissue can form right over the macula to affect central vision.
When the pucker is relatively mild, there may not be any associated vision loss. In severe cases, there can be severe vision loss. Other symptoms are:
- Blurry vision
- Distorted vision
- Straight lines appear wavy looking
- Difficulty distinguishing fine detail
- Difficulty reading small print
- Appearance of a gray area in the central vision
- Experiencing a blind spot
"He is a very caring Doctor, he will not milk your insurance, he will not give you unnecessary surgery if you don't need it. I will never trust anyone else with my vision"- M.H. / Healthgrades / Aug 17, 2016
"Very professional (Dr and staff alike). I was taken aback by the wait time but understood that other people are coming in with emergencies that could cost them their sight if not dealt with immediately. When my turn came, I was not disappointed. I felt like all of his focus was on me. Very efficient and informative documentation."- A.D. / Google / May 30, 2019
"Provides Excellent care and takes time to explain treatment plan"- Anonymous / Healthgrades / May 28, 2019
"I am BEYOND THANKFUL for Dr. Agee!! He went above and beyond to seek the answer to an unusual and complicated issue I was having! He even took the time to consult with an expert on the matter!What a wise and humble man he must be!Dr. Agee, I truly thank the Lord for you!! I believe HE placed His footsteps before me and led me to you! I SO APPRECIATE YOU!! THANK YOU, THANK YOU, THANK YOU!! I pray His blessing upon you and your practice and I am placing you in the center of His hand! May you grow in wisdom and may your clientele' increase exponentially!!"- M.M. / Google / May 22, 2019
"Best eye doctor around no question about it. If you are worried about long wait times, go to a crappy doctor. If you want the best, you have to wait a little"- Anonymous / Healthgrades / May 12, 2019
In order to properly diagnose a macular pucker, a comprehensive eye examination is needed to thoroughly assess the eye, including the retina. Part of this comprehensive exam will include dilating your pupils to give your doctor a better view to examine your retina. Your ophthalmologist might also decide to utilize fluorescein angiography. This test involves your doctor injecting a fluorescent dye into your bloodstream to illuminate the vessels in your retina. To ensure an even more accurate diagnosis, your doctor can use the optical coherence tomography (OCT) test. A laser camera is used to capture pictures of your retina to check for any abnormalities.
Treatment and Prognosis
Commonly, macular pucker requires no medical treatment, where blurred and distorted vision are mild. Many patients can live with a mild distortion or blurriness since daily activities aren’t adversely affected. In some scenarios, the actual scar tissue will separate from the retina to clear up the pucker.
If vision is greatly affected, surgery would be needed to enhance a patient’s quality of life. The vitrectomy procedure will remove and replace vitreous gel with salt water to prevent further tension on the retina. Your doctor will also remove the scar tissue to prevent future complications. An eye patch will be worn for a few days up to a few weeks after surgery to allow the eye to completely heal.
With surgery, most patients can expect an improvement in vision, although it most likely won’t be completely restored. Usually, patients can expect about 50% of the vision lost to the pucker to be returned. Vision distortion can also be greatly improved. On the downside, cataracts can develop after the surgery, which can lead to the need for cataract surgery down the road. Also, there’s a chance of the retina detaching and the possibility of the macular pucker redeveloping, though it’s a slim chance.
Plan Your Procedure
Treat a Macular Pucker
While most people can live with their macular pucker, others are greatly affected by this condition. If you find yourself in this boat, you need to reach out to our experienced staff to see what we can do for you. Please don’t hesitate; give our office a call to schedule your appointment to find out your options.