Macular Conditions

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Macular Conditions

At Retina Associates, LLC, we offer a comprehensive range of treatments for retinal conditions, including those that affect the macula. The macula is at the center of your retina and, as such, is essential to your central vision. It also plays a vital role in your ability to discern vivid color and crisp, sharp detail. The structural integrity of your macula is paramount to the quality of your vision, whether or not you require visual aids to focus at given distances.

As a person ages, there are many macular conditions that can interfere with vision, the most well-known of which is age-related macular degeneration (AMD). Two other potential conditions that can affect the macula are macular holes and macular puckers.

Macular Holes Overview

Like macular degeneration, macular holes interfere with a person’s central vision and are most common among those over the age of 60, though they can affect people at any age. They generally affect only one eye, but can affect both. If you have noticed grey or black spots, blank areas, or other visual distortions (such as normally straight objects appearing bent) in your central field of vision, then you may have macular holes. It is important that you schedule an eye exam immediately.

What Causes Macular Holes?

Unfortunately, the most common cause of macular holes is one that cannot be prevented: aging. Over time, the vitreous – the gel-like substance that fills the eye and allows it to maintain its shape – gradually shrinks and pulls away from the surface of the retina. This is a natural process that is normally harmless. The body compensates by filling the space once occupied by the vitreous with fluid, and most people never experience adverse side effects. In some people, however, the vitreous maintains some of its grip on the retina as it contracts, pulling on it until it tears and creating a hole. At this point, the fluid that replaced the vitreous in the eye seeps through the hole, distorting the central vision.

Although age is the primary culprit behind macular holes, it is not the only one. Other potential causes include:

• Severe myopia
• Retinal detachment
• Diabetic retinopathy
• Injury or trauma to the eye
• In rare cases, macular pucker

How Are Macular Holes Treated?

Although a small percentage of macular holes will resolve without intervention, most get worse without treatment. Fortunately, macular holes can effectively be treated, especially when they are diagnosed early in their formation. The most common treatment for macular holes is a procedure called vitrectomy. This safe, time-tested procedure involves the removal of the vitreous from the affected eye and its replacement with a mixture of air and gas. This mixture forces the torn edges of the macula to remain in place so that they can heal. As the macula heals, the gas and air mixture is resorbed into the body and replaced with natural fluids. Patient may be asked to maintain a face-down position in the post operative period by their surgeon.

Macular Pucker (Epiretinal Membrane) Overview

Macular puckers, also referred to as epiretinal membranes, are a common issue that many people experience later in life. Macular pucker refers to scar tissue that forms on the macula. It can lead to blurry and distorted central vision in many cases.

What Causes Macular Puckers?

The most common cause of macular pucker has to do with the vitreous gel within the eye. As people age, the vitreous can shrink, and in the process of shrinking the vitreous may tug at the retina. When this happens, tears or detachment may occur. Even if there is no tear in the retina, microscopic damage may be present. The retina tries to heal itself by forming scar tissue, which contracts with time and leads to a wrinkle of the retina. While the wrinkle may prove harmless, it can potentially affect the central vision and lead to blurriness or distortion.

What Are the Signs and Symptoms of Macular Pucker?

The most common signs and symptoms of macular pucker include the following:

• Blurry vision
• Wavy vision
• Difficulty reading fine print
• Difficulty seeing fine details
• Blind spots in central vision

Do I Need to Undergo Treatments for Macular Pucker?

In some cases, treatment for macular pucker may not be necessary. Many people who experience macular puckers can continue with their daily lives. Even though their vision is impacted in minor ways, they simply adjust to their vision issues as needed.

However, when a person's vision is seriously impaired by a macular pucker, that is when treatment is necessary. It's important that you meet with a retinal specialist if you should notice any of the above symptoms of the condition.

Vitrectomy for Macular Holes and Macular Puckers

If a person's vision deteriorates to a point where regular daily life is difficult, the best option for treatment is a vitrectomy. During a vitrectomy, the vitreous gel within the eye is removed and replaced with a saline solution. This prevents pulling or tugging on the retina and subsequent formation of scar tissue.

The procedure is very delicate and can improve a patient's vision to some degree. It's important to note, however, that a patient may still experience some degree of vision impairment after treatment. This will still be better than their vision prior to the vitrectomy, though their vision will not go back to normal (i.e., the way it was before the macular hole or macular pucker).

The Vitrectomy Procedure

Macular hole and macular pucker surgeries are typically performed using a local anesthetic, so the patient remains awake during the procedure but is completely comfortable. To begin the procedure, three small holes are created. These holes grant access for the small surgical tools to remove the vitreous from inside the eye.

Once the vitreous has been removed, the surgeon will repair the macular hole or pucker. The eye is then filled with a mixture of air and gas that will put pressure on the macula. In under an hour, surgery should be complete and recovery can begin.