Many living with macular pucker can see fine without treatment. Understand and stay on top of the condition. You can enjoy a good vision for many years to come.Â
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My mom went for an eye exam last week and was found to have some swelling and edema in her macula. My immediate thought is that, like my father, she has been diagnosed with one of the macular edema conditions and would need an eye injection or laser treatment.Â
But, my mom added that the retina specialist she visited referred her to someone else who focuses on surgical procedures that she may need.
This is curious.Â
Knowing that the doctor specialized in treating retinal diseases, why would she need to be referred to someone else? What was the condition that she was diagnosed with?
Soon, I learned that my mom had been diagnosed with macular pucker. Â
Everything makes sense now.Â
She was referred by a medical retina specialist to a vitreoretinal surgeon, who could potentially perform a surgical procedure called vitrectomy.
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What is a macular pucker?
As we get older, our eyesight may start to have problems. One condition that is more common in older adults is called a macular pucker, also known as an epiretinal membrane or macular wrinkle.
This happens when the gel-like substance inside your eye, called vitreous, shrinks and pulls away from your retina. Sometimes a membrane or scar forms on the surface of the retina and causes wrinkles or puckers. If the scar is in the macula area, it can pull the macula out of place and lead to vision distortion.Â
This can also cause swelling and inflammation of the retina, which is known as macular edema, as my mom experienced.
The likelihood of getting macular pucker increases with age, and people with certain eye conditions may get it earlier. Other causes of a macular pucker include eye injury, torn or detached retina, swelling inside the eye, problems with retina blood vessels -- macular degeneration, or after eye surgery, such as cataracts. And it is also linked to diseases such as uveitis or diabetes.
Studies show that 2% of people over 50 and 20% of people over 75 have evidence of a macular pucker, but most don't need treatment. It affects both sexes equally. 10-20% of cases have macular pucker in both eyes, but the severity can vary.
What are the symptoms of a macular pucker?
Macular pucker is a condition that develops gradually and often without any symptoms in the early stages. As it progresses, you may find it difficult to read words or letters, or that some words or details are missing. You may also have trouble seeing fine details clearly. If the macular pucker gets worse, letters or objects may become so blurry that you can't make them out at all.Â
Common symptoms of macular pucker include:Â
- Blurry vision
- Distorted vision
- A small increase in floaters
- Straight lines appearing wavy
- Dark spots in the central vision
- Reduced central vision
As for my mom, similar to many, she experienced slightly blurred vision and saw more floaters. And lucky for her, it only led to mild vision loss.Â
How to treat a macular pucker?
Many people who have macular pucker experience mild symptoms and don't need any treatment. About 5% of people with macular pucker get better on their own, and about 80% stay the same. However, about 15% of people’s vision gets worse over time.Â
For mild cases, your eye doctor may only recommend getting regular eye exams to see if the condition worsens. Your doctor may also suggest using an Amsler grid for self-monitoring of vision at home.Â
In more severe cases, surgery may be necessary. A macular pucker surgery is called a vitrectomy, and it involves removing some of the vitreous gel and scar tissue on the macula. This can help to flatten the macula, improve vision, and relieve symptoms.Â
Your vision may improve after surgery, but it could take months or even a year to reach maximum improvement. About half of the vision lost from a macular pucker may be restored, some more but some less.
Most people do well with the surgery with high success rates, but there are also risks of eye infection, excessive bleeding, a new retinal detachment, and cataract formation. If the surgery is not successful, a repeat of the surgery may be needed.
Some questions to ask when seeing your doctor
When visiting your eye doctor about macular pucker, here are some questions you can ask:Â
- What is the cause of macular pucker? Do I have it in both eyes or just one?Â
- Should I get treatment for my macular pucker?Â
- What treatment is available, and how will it affect my vision?Â
- Are there any side effects or risks associated with the treatment?Â
- Are there any lifestyle changes I can make to help manage my condition?Â
- How often should I have follow-up visits?Â
- Can I join any support groups or resources to learn more?
Final thoughts
Macular pucker is a common condition, especially in older adults, that can lead to vision distortion and mild vision loss.Â
The good news is that most cases don't need any treatment, and the condition may even get better on its own. However, it is important to keep an eye on the condition and have regular eye exams to check for any changes.Â
It is so important to work closely with your eye doctor and understand the condition. With proper understanding, care, and follow-ups, you can help to ensure that your vision remains clear and sharp.
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