mactular traction syndrome vs macular pucker

Hi. I"m 49 years old and in October was diagnosed with a macular pucker. Since my acuity was good at 20/25 -2, a vitreous peel surgery was not suggested and I figured I had time to follow this up slowly. Howver, just recently someone else looked at my optomap photos and said it showed internal retinal derangements (derangements not the word used) and was consisitent with macular traction syndrome and in addition, it looked from the scan like there was already a partial thickness macular hole or impending macular hole. My visual field test (fast test, so a bit noisy) shows 4 blind spots, all in the same quadrant, one quite big; together they take up about 25% of the tested visual field.

my questions are 1) if i am a poor candidate for surgery (I cannot lie face down for more than 5 minutes), does that mean I will go blind in the macular region in that eye? I've read 70% of partial thickness holes go on to destroy vision 1b) is there at least a chance that despite what the optomap looks like, there isn't a macular hole and the traction isn't bad enuf to lead to blindness? (I had an oct, but they took the wrong scan and I will get another this week. I don't have  aretinal specialist yet). Though even if there isn't a hole yet, if I can't have surgery and the traction continues, perhaps there will be a hole and destroyed vision eventually (?)

2) I know causes are usually listed as "aging" and unknown, but is there a chance that getting away from my dry climate would at least prevent it from happening to the other eye (which is now bothering me?). I have sjogren's syndrome as well, and the dry climate of the desert I am in puts me in constant eye pain; i do not use drops. Just seems hard to believe its a coincidence - woudln't dryness cause shrinkage, which could in turn cause traction?

(incidentally, perhaps i should save the following for another time, but I often wonder with an acrylic allergy (to bis-GMA and other acrylates, )I have as well as autoimmune tendencies, whether I would be able to tolerate the artifical lenses put it in the likely event  I develop a cataract after surgery. is that ever an issue for patients, even if rare?).  

incidentally, I'm a professor of higher-level vision, so please don't spare any technical details.

thanks much.

[Ray T Oyakawa, MD]

The surgery for all are technically about the same.  You should have the surgery before there is more damage to the macular area.  Also,  some doctor do not feel you have to be completely face down.  You will cover the macular area with a large bubble if you are on your side.  You should be fine with an IOL implant.

Dr. O.

[promethiusII]

hi- thanks for the info. i'm back from the retinal specialist and will post that in the next message with a question. I agree i should do something before there is more macular damage. but the retinal specialist wants to wait 2 months to see if it stabilizes firstbecause of the risks of surgery. keeps saying "we have time. btmy vision is excellent now and if i wait untl its not, i'll never get that back.