What Is Macular Pucker?

Macular pucker is an extra layer of tissue covering the center of the retina, the light-sensitive tissue in the back of the eye. This extra tissue can bulge or wrinkle and causes changes to your central vision. Other names for macular pucker are epiretinal membrane, preretinal membrane, cellophane retinopathy, and retina wrinkle.

This article will cover what the causes of macular pucker are and its symptoms, diagnosis, and treatment.

Causes of Macular Pucker

Many macular puckers are caused by aging. Over time, the gel-like area in the eye called the vitreous becomes smaller and will pull away from the retina. It will pull away normally in most cases, but sometimes the vitreous will still stick to the retina. This causes scar tissue to form. That scar tissue can make the retina and macula (the center of the retina) wrinkle. If the scar tissue forms over the macula, it can lead to macular pucker.

Other causes of macular pucker include:

• An injury to the eye
• Having eye surgery, such as cataract surgery
• Other specific eye problems like a posterior vitreous detachment, torn retina, or swelling in the eye.
• Having a retinal detachment, which happens when the retina detaches from its normal position in the eye.
• Having uveitis, which is a type of eye inflammation.
• Medical conditions that cause changes in the eye, like diabetes.

Many times, eye doctors (optometrists or ophthalmologists) do not know what exactly causes macular pucker.

Symptoms

The most common symptom of macular pucker is a change to your vision. Here's how macular pucker may affect your vision:

• Your central vision is blurry.
• You have trouble reading small print.
• Straight lines look wavy or broken.
• It's possible to have a blind spot or gray area in your center of vision.

Macular pucker does not affect your peripheral (side) vision. Although you may have some vision changes and vision loss, it's not common to have major vision loss from macular pucker.

Macular pucker is sometimes confused with age-related macular degeneration. Although both can affect your central vision and can have other similar symptoms, they are not the same thing.

Diagnosing Macular Pucker

An optometrist will perform a dilated eye exam to check for macular pucker. For this type of eye exam, you'll receive drops that will make the pupils in your eyes larger to see the back of your eye.

If they suspect a macular pucker, you may also have an imaging test done called optical coherence tomography, or OCT. An OCT uses light waves to get pictures of the retina. It will help your optometrist visualize the macular pucker better and see how much scar tissue has formed. The test is painless.

Treatment

Macular pucker does not always require treatment if it is not affecting your vision.

Eye drops and laser surgery will not help with macular pucker. Instead, your optometrist may ask you to return for more frequent exams to monitor it. This is important because macular pucker can become worse. It also can start out affecting just one eye and then also occur in your second eye. If needed, you can get new glasses or contact lenses to help you see better.

Ophthalmologists can perform a type of surgery called a vitrectomy to remove the scar tissue and some of the vitreous on the macula. This can help return the macula to its correct position. It is an outpatient procedure done under local anesthesia. With a membranectomy, the ophthalmologist can remove the scar tissue covering the retina.

It's usually easier to treat people with a newer macular pucker versus one that has been in the eye for a long time.

A macular pucker can grow back, but this is not common.

Summary

Macular pucker is a sheet of tissue growing over the center of the retina. It can cause changes to your vision, such as making it harder to read small print or causing straight lines to look wavy. Aging is the most common cause of macular pucker.

Optometrists can diagnose macular pucker with a dilated eye exam and OCT. Treatment is not usually needed if your symptoms are mild, although you may need new glasses. If you have more frequent or severe vision changes, your ophthalmologist may recommend surgery like a vitrectomy or membranectomy.

A Word From Verywell

If you know you have a macular pucker and your changing vision gets in the way of everyday activities, let your optometrist know. It may be time to get your eyes rechecked. If you aren't diagnosed with a macular pucker but have changes to your vision without a specific cause, you should also let an optometrist know. Finding the cause of your vision changes as early as possible can make a difference in preserving your vision.