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Macular Holes and Puckers

The macula is a small collection of nerve cells found in the middle of the retina (the back of the eye). Responsible for our central vision, this is the sharp point where the eye focuses the images that we see. When a break develops in these nerve fibers, this is called a macular hole. As we age, the macula can also begin to grow a thin layer of scar tissue over the light-sensitive surface. This is a macular pucker.

Symptoms of Macular Holes

Macular holes are painless but they can seriously affect your vision as you grow older. Most people develop these after age 60; women are more susceptible to the disease. Symptoms can include:

  • Loss of central vision
  • Distortion/blurriness of central vision
  • Straight lines that look wavy

There are three stages of macular holes. The higher the stage, the more impact the disease will have on your vision. Left untreated, the symptoms will continue to worsen.

  1. Foveal detachment
  2. Partial-thickness holes
  3. Full-thickness holes

Symptoms of Macular Pucker

A macular pucker can have some of the same symptoms as a macular hole, although this is not the same as a macular hole and severe vision loss is uncommon with this condition. Symptoms can include:

  • Blurry central vision
  • Mildly distorted central vision
  • Straight lines look wavy
  • Difficulty reading small print
  • Gray spot in central vision
  • Blind spot in central vision

Causes of Macular Holes

Macular holes can be caused by:

  • Diabetic eye disease
  • Macular pucker
  • Detached retina
  • Eye trauma or injury
  • Shrinkage or detachment of the vitreous (jelly-like substance) in the eye
  • Extreme myopia (nearsightedness)

Causes of Macular Pucker

Macular pucker is often caused by the shrinkage or detachment of the vitreous (jelly-like substance) in the eye. When the vitreous pulls away from the retinal surface (a very normal occurrence) the retina will begin to heal the damaged area and form scar tissue. When this occurs on other areas of the retina, there is usually no effect on central vision; however, if it forms on the macula and begins to wrinkle, central vision will be affected. Eye trauma and prior eye surgery can also have an impact on the vitreous and lead to a macular pucker.

Treatment of Macular Holes

Macular holes in Phoenix are most often treated surgically with a procedure known as a vitrectomy. During a vitrectomy surgery, the vitreous gel in the middle of the eye is removed and replaced with an air/gas bubble. The bubble pulls the edges of the hole together and keeps it together as the hole heals. The bubble dissipates on its own and the eye replaces it with its own saline fluid.

Treatments for Macular Pucker

Most macular pucker patients do not require any type of treatment if the symptoms are mild. However, if your vision distortion is affecting your daily activities, a vitrectomy surgery may be performed to remove the vitreous gel to prevent it from pulling on the retina, replacing it with a saline solution. The scar tissue is also removed. This surgery is effective in restoring clear central vision after a few months.

If you are experiencing vision problems in Phoenix, contact Associated Retina Consultants today to schedule a retinal exam. Our doctors can pinpoint the source of your problems, fully explain your treatment options and then provide the necessary treatment to preserve your vision.


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