The back of your eye has a layer called the retina that converts light into signals. Your brain interprets those signals as images.
The middle of the retina has a small area called the macula. It's in charge of your central vision: seeing things directly in front of you. When an extra layer of tissue grows on the surface of the macula, it can cause you to have blurry or wavy vision. This is called macular pucker.
Who’s at Risk for Macular Pucker?
Anyone can get macular pucker. But your odds go up as you age due to normal changes in the eye. In most cases, experts aren’t sure what exactly causes it.
You’re more likely to get it if you have other eye problems like:
- Posterior vitreous detachment. It’s a condition where the vitreous, the gel-like fluid that fills your eye, pulls away from the retina.
- Torn or detached retina.
- Swelling inside the eye.
- Previous eye surgery such as cataract surgery.
- Injury or serious damage to the eye. This can cause scar tissue to grow. This is called epiretinal membranes.
- Problems with blood vessels in the retina.
- Cell growth inside the eye that can pull or wrinkle the macula.
You’re also more likely to get a macular pucker if have certain medical conditions like diabetes or uveitis.
Symptoms of Macular Pucker
For some people with macular pucker, especially if it’s caused by the epiretinal membranes, you might have normal vision. But the scar tissue can get worse over time and cause symptoms.
Macular pucker symptoms can include:
- Blurry or distorted vision.
- Wavy vision. For example, straight lines might start to appear broken.
- Gray, cloudy, or blank space in the middle of your vision.
- Unable to see fine details.
- Symptoms are worse in one eye.
If you notice these symptoms, tell your doctor right away. In rare cases, it can cause severe vision loss. Severe macular pucker could also lead to a rare condition called macular hole.
How Is Macular Pucker Diagnosed?
If your vision is blurry or you’re seeing wavy lines, your primary care doctor will refer you to an ophthalmologist or optometrist, a doctor who specializes in eye problems.
To check your eyes, the doctor will put special eye drops in your eyes to dilate and expand your pupil, the black part of your eye where light enters. This will allow them to use a special lens to look inside of your eyes.
To further test your eyes, they might order a test called optical coherence tomography (OCT). It’s a machine that takes clear, detailed pictures of the back of your eye like the retina and the macula.
The eye doctor will look at the tests and images to see if you have macular pucker. They may refer you to a retinal specialist, an ophthalmologist who specializes in retinal surgery and procedures.
How Do You Treat Macular Pucker?
The type of treatment you get might depend on your macular pucker symptoms. If you have mild symptoms, you might not need any treatment.
But your doctor might do regular eye checkups to make sure the macular pucker doesn’t get worse. They might prescribe glasses to help you see better.
But if your vision is very blurry and makes it hard for you do your day-to-day activities like reading or driving, you’ll need surgery. It’s the only known treatment option for macular pucker. There are two types:
Virectomy. In this procedure, the doctor will remove some of the vitreous that fills your eye. Then, they’ll peel away the scar tissue or membrane growth on your macula or retina that’s causing the pucker or wrinkling.
Virectomy is usually an hour-long surgery. Your doctor might do it at a clinic or office under local or general anesthesia. The surgery doesn’t irritate your eye much, and you can usually get back to normal activities within a few days.
Membranectomy. During this procedure, your doctor will remove the membrane from your retina. This usually takes 30 minutes, and it can be done in a doctor’s office.
What Are the Possible Complications From Macular Pucker Surgery?
As with any surgery, especially when anesthesia is used, complications are possible.
Eye complications can include:
- Retinal detachment
- Hemorrhage or bleeding in the eye
- Infection after surgery
These complications are rare but might cause some level of vision loss. But you may develop cataracts a few months after surgery. If you already have cataracts, they might get worse. You might need cataract surgery to fix this.
If you have questions or concerns about this, talk to your doctor.
What’s the Outlook for Macular Pucker After Surgery?
You’ll probably notice your vision improve or get less blurry a few weeks or months after the procedure. But the recovery timeline is different for each person.
Usually, if your macular pucker started out recently before you opted for surgery, you might see greater improvement in your vision than if you’ve had your pucker for a while.
While it’s rare, it’s possible for a pucker to grow back on your macula after surgery. Tell your doctor if you notice symptoms again.