Macular Holes & Macular Puckers
The central portion of the retina is known as the macula. This part of the retina contains the highest concentration of cones, which are the photoreceptor cells responsible for our central vision and the ability to see fine details. When the macula is damaged, it can affect our vision.
Two of the most common types of macular damage are macular holes and macular puckers (also referred to as epiretinal membranes). These conditions usually don’t cause total vision loss and, in some cases, may just require monitoring. If necessary, they are sometimes corrected through surgery.
What Is A Macular Hole?
A macular hole is just that – a hole that forms in the macula. While rare, an opening may develop as a result of the macula being stretched or pulled. With a macular hole, your vision may deteriorate from the inside out, leaving the outside border intact.
What Is A Macular Pucker?
With a macular pucker, also known as an epiretinal membrane, a thin, semi-transparent layer of scar tissue grows over the macula. As this scarring can cloud and narrow your scope of vision, you may find it difficult to see, although any changes may not be immediate. Over time, the pucker can grow, spread, and contract, resulting in the retina becoming very wrinkled or “puckered.” Anyone can develop this condition, even if you’ve never had eye or vision issues. Puckers can also sometimes indicate underlying problems, such as eye disease or trauma.
Symptoms of Macular Holes and Puckers
Both macular holes and puckers may not interfere with your ability to see especially if your other eye is healthy. However, you may find that your vision is distorted and blurred. In most cases, macular holes and puckers only impact your central vision, leaving your peripheral vision unaffected. In some cases, a macular pucker can develop into a macular hole, although this is rare. only affect central vision, preserving peripheral vision, and total blindness doesn’t develop. A macular pucker can develop into a macular hole, although this is rare.
Are Macular Holes and Puckers the Same as Age-Related Macular Degeneration?
Macular holes, macular puckers, and age-related macular degeneration (AMD) all share similar symptoms, and typically affect people over the age of 60. However, they are three separate conditions that require a diagnosis from an ophthalmologist or retina specialist.
Common Causes of Macular Holes and Puckers
Typically, aging is the leading cause of both macular hole and pucker development. Specifically, these conditions occur due to a common condition known as posterior vitreous detachment (PVD). PVD targets the vitreous humor, a clear gel that maintains the eye’s shape. As we age, the vitreous naturally shrinks and diminishes in thickness. While this typically doesn’t cause any issues, the vitreous can sometimes be extra sticky and adhere to the retina; as the vitreous shrinks away, it pulls on the retina, causing damage to the macular tissue. In addition, cellular debris can build up in the vitreous, forming a macular pucker.
Diagnosing And Treating Macular Holes and Puckers
A comprehensive eye exam is necessary to diagnose macular holes and macular puckers. Both eyes will be dilated, with special eye drops applied to widen your eyes, providing an unobstructed view of the retina and the back of the eye.
To diagnose macular holes, your doctor may use a test called optical coherence tomography (OCT). This non-invasive imaging test uses infrared light waves to capture detailed, high-resolution, cross-sectional images of the structures within your retina. OCT only takes a few minutes, and your eyes are untouched through the test.
Treatment of Macular Holes and Macular Puckers
In most cases, macular holes and puckers may not require treatment, as they do not affect your vision. Regular follow-up appointments will be needed, though, to monitor your macular health.
Macular Hole Treatment
If a macular hole causes vision problems, you may require a vitrectomy to repair the hole and prevent permanent vision loss. This procedure involves the complete removal of the vitreous, as well as some macular surface tissue. The surgeon injects a gas bubble into your eye, which serves as a temporary bandage that holds the hole’s edges together, helping it to close.
Post-surgery, you’ll have to limit movement, especially your head, to keep the bubble in the right place and allow the macular hole to heal. You should also avoid flying or getting nitrous oxide (laughing gas) for any medical procedures until the bubble is completely gone, as these activities can affect eye pressure.
Macular Pucker Treatment
Aside from regular monitoring, with macular puckers, your ophthalmologist may recommend you wear eyeglasses or update your current prescription to improve your vision. If your central vision and close-up activities (e.g. reading or seeing faces) are affected, surgery may be needed.
A vitrectomy is a common treatment option for a macular pucker. Or, you may undergo an in-office procedure known as a membranectomy, in which a surgeon removes the membrane from your retina. Typically safe and effective, it takes less than 30 minutes.
Schedule a Macular Hole or Macular Pucker Consult in Utah
Macular holes and puckers, if untreated, can cause retinal damage and impact your central vision. If you suspect these conditions or have questions, please contact us at Retina Associates of Utah for an appointment.