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
"Recently I had an ongoing issue and was passed around to several ophthalmologists via referral. Finally I ended up in Dr. Sullivan's hands. I will say several women I work with had strongly recommended him, and advised me (combined with having been to an ophthalmology appointment 3 times already in a one month span) that I would wait. The receptionist who confirmed my appointment also reminded me "you can expect to be at the appointment up to 4 hours" so it seems my expectations were a little different than some others. When I finally did get to see Doctor Sullivan (an hour and a half or so after my appointment time) he made an extremely scary situation so much better. He has amazing bedside manner and his delivery is understanding. I was really emotional and he assured me he was confident in his diagnosis and resolution. I left the appointment feeling 100 times better & completely happy I ended up in Dr. Sullivan's hands!"- W.T. / Yelp / Jul 19, 2018
"The staff is awesome. Friendly and always smiling?"- D.B. / Facebook / Jun 21, 2018
"Dr Sullivan was awesome !! I took my sister and he was on top of it right away!! She has a huge mass behind eye!! I would recommend them highly ????"- S.B. / Facebook / Jun 02, 2018
"Goes above and beyond for patients. Very detail oriented. Works well with other Dr if you have multiple eye issues such as glaucoma. There are long wait times in the office but it is well worth it. Dr. Sullivan is the primary Dr at the office but have had to see Dr Agee and he is great too. Highly recommend this office and doctors."- S.V. / Google / May 27, 2018
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.