Macular Hole & Macular Pucker

The retina is the photosensitive tissue lining the back wall of the eye and the macula is the central region of the retina. The macula is the region that allows one to have reading vision and perform tasks that require high definition.

What is a macular hole?

A macular hole is caused by a defect in the very center of the macula with the symptoms being the loss of reading vision. Although blunt trauma to the eyeball can cause a macular hole, the usual causes are attributed to an aging process called posterior vitreous detachment (PVD). Although untreated macular holes do not lead to blindness when diagnosed early (within one year after the onset of symptoms), vitrectomy surgery has a good chance of recovering significant vision. A gas bubble is commonly utilized as an adjunct to such surgery.

What is a macular pucker/epiretinal membrane?

For reasons not understood, the separation of the vitreous gel inside the eye (posterior vitreous detachment – PVD) can be associated with a reparative process in which fibrous cells form a film on the surface of the macula. This film of tissue is often called an epiretinal membrane or a macular pucker. This film of tissue has contractile properties that can cause the surface of the macula to wrinkle. This wrinkling can elicit symptoms such as distortion and blurring of vision. When the symptoms become bothersome enough, vitrectomy surgery to remove the film may be beneficial.

How are macular holes and macular puckers diagnosed?

Macular holes and macular puckers both cause disturbances of central vision. The symptoms of macular holes and macular puckers may be similar to the symptoms of wet macular degeneration, but the treatments and their urgencies are vastly different. If one notes central blurring with distortion, then an evaluation by an ophthalmologist would be recommended. Imaging studies that include optical coherence tomography (OCT) are often utilized.