The macula, which is located in the center of the retina, enables clear central vision and the ability to discern fine details. With age, some people form scar tissue on the macula — usually due to the aging process, inflammation in the eye, trauma or another disorder. This distortion is known as a macular pucker, and it can have serious visual ramifications.
To avoid irreversible vision loss, macular pucker and other problems with the macula should be evaluated and treated.
What Causes a Macular Pucker?
With age, the vitreous (the clear gel-like substance that fills the eye’s inner chamber) starts to shrink and pull away from the surface of the retina. In some cases, this causes tiny areas of damage on the surface of the retina. The body responds by activating its healing process and forming scar tissue over the affected area. This scar tissue may contract or morph, causing the retina to wrinkle or pucker. If the scar tissue covers the macula, central vision can become blurred or distorted.
Macular pucker is also associated with the following eye conditions:
- Torn or detached retina
- Eye inflammation
- Trauma to the eye
- Previous eye surgery
- Diabetic retinopathy and other blood vessel disorders
Macular puckers have symptoms similar to those associated with macular degeneration and macular holes, but they are distinctly different conditions. With a macular pucker, vision may be blurry with mild distortions, and straight lines may appear wavy. Fine details, such as small print, can be difficult to capture. In some cases, there is a gray area or blind spot in the center of the visual field.
Macular pucker is diagnosed during a dilated eye exam. A test called a fluorescein angiography, which uses dye to highlight areas of the retina, may be performed. Optical coherence tomography can also be helpful to scan the retina and provide a cross-sectional image of the retina; it is good for picking up very small abnormalities in the macula that might be missed during a regular exam or angiography test.
Treatment Options for Macular Pucker
Not all cases of macular puckers need to be treated; many people with the condition adjust to the visual distortion and it does not present significant interference with daily life. The scar tissue can separate from the retina and the macular pucker disappears. Prescription eyeglasses can help improve vision to a manageable level.
If macular pucker symptoms are more severe and interfere with daily activities, like reading or driving, surgery is a viable treatment option. A procedure known as a vitrectomy is performed to remove part or all of the vitreous gel so it can no longer pull on the retina, and it is replaced with a salt solution. The scar tissue responsible for the wrinkling is also removed. An air or gas bubble may be placed in the eye to seal holes or tears and aid the retina as it heals.
After the scar tissue has been cleared, the macula flattens and vision improves gradually. It can take up to three months for vision to recover. Vitrectomy is likely to reduce a significant portion of the visual distortion of macular pucker. For most people, the procedure restores about half of the vision lost (sometimes more and sometimes less).