In this episode Dr. Suh interviews Dr. Chirag Patel,  a retina specialist, about two conditions that can affect central vision - macula puckers and macular holes. 

Patients with a macular pucker (also called epiretinal membrane, epimacular membrane, cellophane maculopathy, and surface wrinkling retinopathy) will have symptoms of distortion or blurred vision that does not go away. A pseudohole is a variant of a macular pucker that looks like a macular hole.

The majority of puckers occur spontaneously and without a cause (idiopathic). Secondary causes make up around 10-20% of cases and can be from from diabetic retinopathy, retinal vein occlusions, retinal tears and detachments, and trauma. After the age of 50, 2% of the population may have a macular pucker while 20% of people over 75 may have one. If there is a secondary reason for the pucker, this can occur at any age.

Macular holes will also cause symptoms of blurring and distortion. The patient may also notice a missing area in the center of their vision. The cause of macular holes is probably related to the vitreous gel tugging on the macular region. This traction can pull off the center part of the macula and leave a hole. Macular holes can also occur after ocular trauma. People over 60 are more likely to have a spontaneous macular hole. Females are more prone to have them than males, unlike with puckers where females and males have about the same incidence.

Diagnosis of both of these conditions can be done by direct examination of the macula and by OCT (optical coherence tomography). Patients with macular issues should monitor their vision with an Amsler grid to look for distortion or missing areas. 

Medications and lasers cannot be used to treat either condition. Surgery is the only treatment. Macular pucker surgery is only performed if the patient has bothersome visual symptoms. Patients with macular holes should have surgery when the retina specialist recommends it. Visual recovery after these surgeries may be slow, and patients may not recover 20/20 vision afterwards. The surgery should improve the distortion or the missing area in the center.

The Retina Group, Dr. Patel’s practice, has excellent resources and surgical videos about macular puckers (epiretinal membranes) and macular holes on its website.

Here are some other websites for more information on macular puckers and macular holes. 

Learn more about Dr. Patel and his practice at their website and Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.