Macular Pucker

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.

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.

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.

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.

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.

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.

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.

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.