To prevent wrinkled retina, consider incorporating the following foods into your diet:- Citrus Fruits: Including oranges and grapefruits, which are good sources of vitamin C.
These foods can help support retinal health and potentially reduce the risk of age-related eye conditions. - 4 Sources
- Citrus Fruits: Including oranges and grapefruits, which are good sources of vitamin C.
These foods can help support retinal health and potentially reduce the risk of age-related eye conditions. - 4 Sources
Surgery is the most complete treatment, but your provider may treat you with magnifiers or glasses. What is macular pucker? A macular pucker is a wrinkling of your retina due to scar tissue. Other terms for this scar tissue are epiretinal membrane (ERM) or cellophane maculopathy.
What Causes Puckering of the Macula and How Is It Treated?
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https://www.visioncenter.org/conditions/wrinkled-retina/
Fundus photo of macular scarring with normal blood vessels and optic nerve
A macular pucker is a scar tissue or wrinkle on the eye’s retina. It affects the eye’s ability to focus clearly on objects.
In this article, we’ll explore this condition and offer insights into the following:
- What a macular pucker is, and what causes it
- Symptoms of a macular pucker
- Diagnosis of a macular pucker
- Available treatments for macular pucker
What Is a Macular Pucker?
A macular pucker, or wrinkled retina, is scar tissue that forms on the macula. The macula is the central area of the retina responsible for detailed vision.1
Other names of macular pucker are:
- Retinal folds
- Cellophane maculopathy
- Epiretinal membrane (ERM)
- Preretinal membrane
- Surface wrinkling retinopathy
- Pre-macular fibrosis
- Epimacular membrane
The retina is the light-sensitive back layer of the eye. It sends visual signals to the brain for interpretation, with its center (macula) being the enabler of detailed vision.
Effect of a Macular Pucker
When scar tissue forms on the macula, the ability of the retina to focus light is impaired, resulting in blurry vision. Your eye won’t be able to focus light properly, even if you wear eyeglasses.
Retinal folds or a wrinkled retina are generally not a serious condition and most people experience only mild vision distortion that may not require any treatment. In rare cases, however, it can result in severe vision loss or lead to a related condition known as a macular hole.
Disability Considerations
According to the Americans with Disabilities (ADA), a disability is any physical or mental impairment that substantially limits one or more major life activities.
A macular pucker isn't considered a disability because it does not completely impair your ability to see. This distinction is important for understanding how macular pucker affects daily life and what legal and social definitions of disability it does not meet.
Symptoms of a Macular Pucker
Most cases of macular pucker have mild symptoms that may get worse with time. Someone with a macular pucker may experience the following:
- Straight lines like electric cables, line grids, or railway lines appear wavy
- Blurry vision
- Difficulty seeing clearly, even with glasses
- Double vision (diplopia)
- Image by the affected eye may appear larger size (macropsia)
Some people get used to the changes in vision. If you’re concerned or notice any changes in your vision, talk to your eye doctor.
Does Macular Pucker Cause Floaters?
A macular pucker does not cause floaters.5 However, floaters are a good indicator for related causes of macular pucker, such as retinal tear, posterior vitreous detachment, and diabetic retinopathy.
What Causes a Wrinkled Retina?
Most cases of macular puckers are idiopathic.3 This means that there is no known cause. However, scientists agree that aging plays a major role in the wrinkling of the macula.
The vitreous is a clear liquid that fills the eye and gives it a round shape. The vitreous slowly shrinks as you age and pulls away from the retina.
Usually, it pulls away and separates without any problems in a process called posterior vitreous detachment (PVD).4 However, the vitreous may sometimes pull away without detaching, leaving membrane or scar tissue and causing a wrinkled retina.
Who Is at Risk for a Macular Pucker?
Macular puckers are common among people aged 50 or older. The National Institute of Health reports that 20% of people aged 75 or over have macular puckers.2
However, you can develop a macular pucker at any age. Your risk of macular pucker is higher if you:
- Have small dark spots, threads, or cobwebs floating across your vision (floaters)
- Have a history of vitreous detachment
- Have a history of retinal tear or retinal detachment
- Have a history of uveitis or eye inflammation
- Have retinal blood vessel disorders
- Had eye surgery, including cataract surgery
- Had severe eye injury
A macular pucker usually occurs in one eye, but both can be affected. Most people experience only mild visual distortion that may worsen gradually.
Macular Pucker Diagnosis
Your doctor will check for macular pucker during a dilated eye exam. Your doctor will use dilating eye drops to widen your pupil and examine the inner parts of your eye.
If macular pucker is suspected, they’ll perform other confirmatory tests such as:
- Amsler grid eye test. A page of small squares made of horizontal and vertical lines is used to check whether straight lines appear wavy or distorted.
- **Optical coherence tomography (OCT).**6 This test examines the thickness of your macula and detects any swelling or visual distortion. It also assesses treatment effectiveness.
- Fluorescein Angiography (FA). This test examines retinal blood circulation. Photos of your eyes are taken to check for potential leakage as blood flows through the eye.
Treatment Options for Macular Pucker
Most people with macular puckers have mild symptoms and do not require treatment. However, healthcare professionals encourage regular eye exams to ensure the condition does not worsen.
Your eye doctor may recommend a new eyeglass prescription, reading lamps, and other magnifiers to improve visual acuity. If a macular pucker affects your quality of life by hindering important activities such as reading and driving, your eye doctor may recommend surgery.
Common surgeries for macular pucker include:
- Vitrectomy surgery. An outpatient procedure that involves removing some vitreous gel and peeling off the abnormal membrane from the retina’s surface
- **Membranectomy.**7 Removal of the abnormal membrane from your retina using precision surgical instruments; it doesn’t involve vitreous gel removal
- **Fluidic Internal Limiting Membrane Separation (FILMS).**8 A new procedure still under development; after vitrectomy, a fluid is injected between the membrane and the retina, causing the scar tissue to lift away
Is Surgery Effective for a Macular Pucker?
Surgery will significantly improve your distorted central vision. However, the exact outcome is hard to predict.
Not undergoing the recommended surgical procedure increases your risk of complications such as severe vision loss or macular holes. However, full blindness is impossible since macular puckers only affect central vision and not peripheral vision.
What to Expect After Treatment
After surgery, an eye shield will be placed over your eye for protection. Wear the eye shield for at least the first 24 hours. You’ll also receive eye drops to help reduce inflammation and prevent infection.
Any applied stitches will dissolve within 4 to 6 weeks. Your eyes may feel gritty and appear red while the stitches are present. Full recovery can take about 3 to 6 months.
Post-Surgery Care
To reduce pain and prevent ocular pressure on your treated eye, the American Academy of Ophthalmology (AAO) recommends sleeping face down, with the operated eye hanging off the edge of the bed.9 Do this for a period recommended by your doctor.
You can use special equipment such as face-down pillows, chairs, and mirrors to help you maintain your position. You’ll also be required to moderate certain activities to ensure a successful healing process.
These activities include:
- Driving
- Intense exercise
- Swimming
- Air travel
- Applying make-up
- Rubbing your eyes
If you experience severe pain, worsening vision, or any concerning side effects, consult your doctor for better management.
Summary
- A macular pucker, or wrinkled retina, is scar tissue that forms on the macula, the central area of the retina responsible for detailed vision.
- A macular pucker usually occurs in one eye, but both can be affected. Most victims experience only mild vision distortion that may worsen gradually.
- Common symptoms of macular pucker include blurry vision, floaters, double vision, etc. Frequent eye exams can help monitor any worsening symptoms.
- Most cases of macular pucker do not require treatment. In severe cases, eye doctors recommend surgery to restore vision.
- See your doctor's advice if you experience blurry vision or any concerning symptoms.
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Macular Pucker
Overview
What is macular pucker?
A macular pucker is a wrinkling of your retina due to scar tissue. Other terms for this scar tissue are epiretinal membrane (ERM) or cellophane maculopathy. The retina is the part of your eye covered with special nerve cells that react to light.
These nerve cells are very close together in the middle of your retina where the lens of your eye focuses the images that you see. The macula is the small part of your retina where the light-sensing cells come together.
A macular pucker doesn’t always cause significant issues with your vision, but it can distort your vision in some cases.
How common is macular pucker?
Recent studies estimate that 18.8% to 34.1% of Americans have macular pucker. The risk increases with age. Fortunately, most of these individuals don’t develop poor vision.
Symptoms and Causes
What are the symptoms of macular pucker?
The main symptom of macular pucker is distorted central vision. Straight lines appear to be wavy. Another term for this type of distorted vision is metamorphopsia.
While it can affect both eyes, it’s more common for macular pucker to affect only one eye. If you do have it in both eyes, one eye will probably be worse.
In addition to wavy vision, you might find that you aren’t able to see as clearly as you once did, no matter how close you are to what you’re looking at. You may also see a double image, or the image from one eye may seem larger than the other. Importantly, eyeglasses can’t fix the poor vision caused by macular pucker.
What causes macular pucker?
- Tears in the retina.
- Prior history of retinal detachment.
- Prior eye surgery.
- Eye trauma.
- Infection.
- Diabetes-related retina disease.
- Eye inflammation.
Is macular pucker contagious?
No, macular pucker isn’t contagious. You can’t get it from anyone or spread it to anyone else.
What are the risk factors for macular pucker?
In addition to getting older, you may be at a higher risk of macular pucker if you:
- Have a separation of the vitreous humor from the retina.
- Had laser eye therapy or eye surgery, including cataract surgery.
- Had a retinal tear or detachment.
- Had uveitis or eye inflammation.
- Have diabetes-related retinopathy.
- Had severe eye injury.
What are the complications of macular pucker?
Macular pucker may lead to some vision loss. It isn’t likely to cause blindness.
Diagnosis and Tests
How is macular pucker diagnosed?
Your eye care provider will do a thorough eye exam after asking you about your symptoms and taking a medical history. They’ll give you eye drops to dilate your eyes (make them open wide) so they can see your retina.
What tests will be done to diagnose macular pucker?
During your eye exam, your provider will use a light and magnifier to get a close look at your eyes. They may also use the following tests to diagnose macular pucker:
- Amsler grid eye test, which checks for distorted vision using a page of small squares formed by horizontal and vertical lines.
- Optical coherence tomography, an imaging method that takes pictures of your retina.
Management and Treatment
How is macular pucker treated?
You may not need treatment for macular pucker. Your provider may consider just monitoring your condition. If you do need treatment, there are noninvasive and surgical options.
Noninvasive treatments for macular pucker
- A new prescription and new eyeglasses. Eyeglasses won’t fix the problems caused by macular pucker, but a new prescription may be able to optimize and improve your overall vision.
- Good lighting, such as reading lamps.
- Magnifying devices.
Surgical treatments for macular pucker
- Vitrectomy with membranectomy, an outpatient procedure that removes the scar tissue or membrane from the retina.
What are the complications of treating macular pucker with surgery?
Your healthcare team will take every precaution to avoid complications, but there’s always a small risk during any surgery, including:
- Bleeding.
- Infection.
- Retinal tear or detachment.
- Worsening of cataracts.
- Macular hole.
- Glaucoma or high eye pressure.
How soon after treatment will I feel better?
After a vitrectomy, you’ll probably have imperfect vision for a few days. Your eyes may be irritated and tender for a little while.
You’ll probably need to take two to four weeks off work or school.
You won’t be able to drive right away. It could even take up to 3 months to enjoy the full benefits of improved vision after surgery.
Outlook / Prognosis
What can I expect if I have macular pucker?
Most cases of macular pucker don’t need treatment. You’ll just need to have eye exams on the schedule your provider sets up for you to monitor your vision and eye health.
You may have some vision problems with macular pucker, but it’s not likely to cause blindness.
Prevention
Can macular pucker be prevented?
In some cases, where a cause is unknown, there’s no way of preventing it. Avoiding diabetes-related eye disease and eye trauma are some ways to help prevent it.
Living With
How do I take care of myself if I have macular pucker?
Ways to take care of yourself include:
- Keeping your scheduled eye appointments.
- Following general guidelines for good overall health, like eating healthy foods and getting appropriate amounts of exercise.
- Following guidelines for good eye health, like wearing sunglasses, washing your hands before touching your eyes and following your provider’s advice about wearing contact lenses safely.
- Stop smoking. Smoking isn’t good for your eyes. If you smoke, ask your healthcare provider for help with quitting.
When should I see my healthcare provider?
If you have any changes in your eyesight, you should contact your healthcare provider. If you have sudden changes in vision or sudden eye pain, get immediate medical help by calling 911 or going to the emergency room.
Additional Common Questions
Is macular pucker the same as macular degeneration?
No but their symptoms can be similar. Macular pucker and age-related macular degeneration are two different conditions, but they both affect the macula. These conditions don’t usually affect your peripheral vision.
Is macular pucker the same as a macular hole?
No. A macular pucker isn’t the same as a macular hole. A macular hole is an actual hole, while a pucker is a wrinkle in the retinal tissue. A pucker can sometimes lead to macular hole. Vision symptoms are more severe with a macular hole, and surgery is usually necessary.
A note from Cleveland Clinic
When you first hear that you have a condition that can affect your vision, like macular pucker, you might be worried. Many cases of macular pucker don’t need treatment. Your provider will discuss your options with you and help you figure out the best way forward. It’s important to get regular eye examinations. Your eye care provider can tell you what kind of schedule to follow.
Retinal health and issues: Retinal detachment from the American Society of Retina Specialists
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