Macula Pucker

[ccbc]

I now add a new diagnosis to my repertoire.  I am legally blind in my right eye and my left eye is a -16.50-17.00.I have myopic macular degeneration, lattice dystrophy, had pvd, and two retinal tears.  Last Thursday I was diagnosed with a macula pucker in my left eye.  I will be seen by another retinal specialist on Tuesday.  The Amsler grid is wavy and I know there is some loss of mid and near vision.  I have had big webbing and floaters for years.  Yes, I am frightened by yet another additional eye problem and I am fifty-five years old.

[AnnaE]

I do hope your vision stabilizes.
You are so correct in telling ccbc to avoid negative people, and to seek support, caring, and friendship.

Yes, we are terrified at the prospect of vision loss. However, we must retain our belief that are lives are always potentially rich in value for ourselves, and for others.

[berrywoo]

I understand your fear of losing your vision. It is a very scary thought to think that you may possibly lose you're sight and not be able to do the normal day to day activities in the same manner that you're accustomed too. However, losing your vision doesn't mean the end of life. It just means you have to make some adjustments. Things may be difficult and you may be frustrated at first, but things will get easier w/ time.

I don't have a macular pucker, but I do have the use of only one eye. Both of my eyes have suffered repeated retinal detachments. My left eye, after four corrective attempts plus a fifth procedure to remove silicone oil, has irreparable nerve damage which translates into only light perception and maybe some hand motion. My right eye has also undergone four surgical procedures. They have resulted in a huge loss of my visual field and my visual acuity is 20/80. Also, there is still scar tissue that may threaten the stability of the retina of my right eye.

I'm 23 years old and given my history there is a huge chance that I may end up losing more vision. It does frighten me. There are days when I'm frustrated and overwhelmed by my lack of vision, and I want to just curl up in bed and cry. However, I know that letting all the negative emotions take over would be doing myself a disservice.

Surround yourself w/ positive people, friends and family. There are a wide variety of support groups for the visually impaired which you can take advantage of. Try calling your local department of services for the blind. Also, don’t be afraid to ask for help.

I wish you the best of luck. Take care.

[ccbc]

I have no concern about pain of an operation. The concern of course is for retinal detacnment.  I do not another usable eye and therefore would be stuck sitting on a sofa unable to drive, read, or even watch tv.

[JodieJ]

Most macular puckers (aka epiretinal membrane, epimacular membrane) require no treatment beyond observation.  Many people are not even aware that they have the condition.  If surgery to peel the membrane (a layer of scar tissue) is recommended for you, I can assure you that the procedure is neither painful nor particularly dangerous.  I actually went to the movies (wearing an eye patch) that afternoon.  (Of course, you can stay home and relax if you prefer.)  Your recovery should be fairly rapid.  

[jegjr]

Hi, Dr. Feldman -

Could you please comment on whether corrective lenses will improve vision w a dx of macular pucker? I would like to avoid surgery if possible.

Thank you.

Jim Gosney

[Sandy Feldman, MD, MS]

Dear ccbc,

I am sorry that my answer did not fully address your question about macular pucker.  I wanted to make sure that you have been refracted as an incorrect prescription can make the vision symptoms worse.  The loss of vision in midrange and near may be a normal phenomenom associated with aging, known as presbyopia.  The eye loses the ability to accommodate which results in difficulty focus at close and midrange.  This can be corrected or improved with reading glasses.  Often, retinal specialists do not refract patients so I wanted to make sure that you have been checked and some simple things not overlooked.  

Macular pucker is a disease in which scar tissue forms in the area of one’s best vision.  It may cause distortion of sight, blurriness and some waviness of lines [as evidenced on Amsler grid testing].  Your trouble with close vision may also be a result of the macular pucker.  There are a number of different names for macular pucker including epiretinal membrane or cellophane retinopathy.  The treatment for macular pucker depends upon the visual symptoms.  

Sometimes, it can require surgical intervention in which a vitrectomy is performed and the membrane is peeled.  As this is your only good seeing eye, you should really speak with your retinal specialist about the implications of surgical intervention or observation.  It may take up to three months for recovery and not all patients benefit from surgical intervention.  It is important to get questions answered to the best of your ability before you undergo surgery.  I would advise you to seek the opinions of one or two or three retinal specialists, especially in view your history of only one eye with good vision.  

I wish you well.

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[AnnaE]

I share many of your concerns. I lost 80% of my vision in the left eye dure the last year, due to retina detachments and five surgeries. I have had tears and holes in my right eye. It has been lasered extensively, including cerclage, or 360 lasering. I also have ERM in the right eye, but it has not progressed so far. I also have lattice degeneration, and both my daughter's retinas have detached--she fully recovered.

I see that you live in Houston. Houston has many highly rated doctors. If you will go to Castle Connelly.com, you will find those retinologists.

I hope you feel better. My mood does not stray much from distressed. I will go to Houston, or another city soon, to make sure my treatment is the best I can get. I am in a sort of backward city. I usually say unsophisticated, but my patience is running out.

You might also ask you doctor about cerclage, to protect your good eye. In fact, I would get 2-3 opinions before doing it. You can do a search here on the discussions I have started on this. It is only OK to consider if your have had PVD, FYI. I see you have.

I wish the best for you.

[JodieJ]

I can appreciate your concern about RD.  Macular pucker surgery does increase your risk slightly.  (My retinal surgeon told me it incresed risk by about 2%.)  Some good news for you:  For whatever reasons, the RD rate is significantly lower among females than males.

Have you been told that you need retinal surgery?  It is not indicated in the majority of cases, since the pucker generally has only a limited effect on vision.  It's only in a minority of cases (like mine) that the scar tissue continues to develop over time, with a resulting decline in vision.  Hopefully, the retinal specialist you'll be seeing will address all your concerns.    

[ccbc]

With a history of myopic macular degeneration from 1995, I don't understand your comments that my acuity issues are simply related to aging.   Since I have worn corrective lenses from age 3 I am highly aware of my pathological state of myopia and amblyopia.  What I hope to gain from this board was info about macular pucker along with other patient's experience with this problem.  The fact that this condition affects my only eye with useful vision is a problem.  

[Sandy Feldman, MD, MS]

You are highly nearsighted and have numerous eye complications associated with this.  The loss of mid and near vision may be related to the normal aging process.  I would recommend that you see an excellent refractionist, an eyeMD who prescribes glasses well.

Additionally, it is quite understandable that you are concerned about the changes in the macula and about your vision.  Do you have any medical conditions or family history of this as well?  Make sure that you have a doctor who feels comfortable treating your retinal conditions and that you feel comfortable with as well.  It is understandable that you are concerned about this. Get your questions answered and seek another opinion from a retinal specialist if needed.