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Macular Pucker
Epi-retinal Membrane (Macular Pucker)
Epi-retinal membrane (ERM) or macular pucker is a cellophane-like
membrane that forms over the macula. It is typically a slow-progressing
problem that affects the central vision by causing blur and distortion. As it
progresses, the traction of the membrane on the macula may cause swelling.
ERM is seen most
often in people over 75 years of age. It usually occurs for unknown reasons,
but may be associated with certain eye problems such as:
diabetic retinopathy, posterior vitreous detachment,
retinal detachment, trauma, and many others.
Signs and Symptoms
§
Blurred vision
§
Double vision that is noticeable even with one
eye covered
§
Distorted vision (straight lines may appear
bent or wavy)
A macular pucker is scar tissue that has formed on the
eye's macula, located in the center of the eye's light-sensitive tissue called
the retina. The macula provides the sharp, central vision we need for reading,
driving, and seeing fine detail. A macular pucker can cause blurred and
distorted central vision.
Most of the eye's interior is filled with vitreous, a
gel-like substance that fills about 80 percent of the eye and helps it maintain
a round shape. The vitreous contains millions of fine fibers that are attached
to the surface of the retina. As we age, the vitreous slowly shrinks and pulls
away from the retinal surface. This is called a vitreous detachment, and is
normal. In most cases, there are no adverse effects, except for a small increase
in floaters, which are little "cobwebs" or specks that seem to float about in
your field of vision.
However, sometimes when the vitreous pulls away from the
retina, there is microscopic damage to the retina's surface (Note: This is not a
macular hole). When this happens, the retina begins a healing process to the
damaged area and forms scar tissue, or an epiretinal membrane, on the surface of
the retina. This scar tissue is firmly attached to the retina surface. When the
scar tissue contracts, it causes the retina to wrinkle, or pucker, usually
without any effect on central vision. However, if the scar tissue has formed
over the macula, our sharp, central vision becomes blurred and distorted.
Most macular puckers are related to vitreous detachment,
which usually occurs in people over age 50. As you age, you are at increased
risk for macular pucker.
A macular pucker can also be triggered by certain eye
diseases and disorders, such as a detached retina and inflammation of the eye (uveitis).
Also, people with diabetes sometimes develop an eye disease called diabetic
retinopathy, which can cause a macular pucker. A macular pucker can also be
caused by trauma from either surgery or an eye injury.
Vision loss from a macular pucker can vary from no loss to
severe loss, although severe vision loss is uncommon. People with a macular
pucker may notice that their vision is blurry or mildly distorted, and straight
lines can appear wavy. They may have difficulty in seeing fine detail and
reading small print. There may be a gray area in the center of your vision, or
perhaps even a blind spot.
Is a macular pucker the same as age-related macular
degeneration?
No. A macular pucker and age-related macular degeneration are
two separate and distinct conditions, although the symptoms for each are
similar. An eye care professional will know the difference.
Can macular pucker get worse?
For most people, vision remains stable and does not get
progressively worse. Usually macular pucker affects one eye, although it may
affect the other eye later.
A macular pucker and a macular hole are different conditions,
although they both result from the same reason: The pulling on the retina from a
shrinking vitreous. When the "pulling" causes microscopic damage, the retina can
heal itself; scar tissue, or a macular pucker, can be the result. If the
shrinking vitreous pulls too hard, it can tear the retina, creating a macular
hole, which is more serious. Both conditions have similar symptoms - distorted
and blurred vision. Also, a macular pucker will not "develop" into a macular
hole. An eye care professional will know the difference.
A macular pucker usually requires no treatment. In many
cases, the symptoms of vision distortion and blurriness are mild, and no
treatment is necessary. People usually adjust to the mild visual distortion,
since it does not affect activities of daily life, such as reading and driving.
Neither eye drops, medications, nor nutritional supplements will improve vision
distorted from macular pucker. Sometimes the scar tissue--which causes a macular
pucker--separates from the retina, and the macular pucker clears up.
Rarely, vision deteriorates to the point where it affects
daily routine activities. However, when this happens, surgery may be
recommended. This procedure is called a vitrectomy, in which the vitreous gel is
removed to prevent it from pulling on the retina and replaced with a salt
solution (Because the vitreous is mostly water, you will notice no change
between the salt solution and the normal vitreous). Also, the scar tissue which
causes the wrinkling is removed. A vitrectomy is usually performed under local
anesthesia.
After the operation, you will need to wear an eye patch for a
few days or weeks to protect the eye. You will also need to use medicated eye
drops to protect against infection.
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