Your macula is part of your retina, located at the back of your eyeball where the visual process begins. (Learn More) A macular pucker occurs as part of the aging process, and it is the result of scar tissue on the macula. (Learn More)

The major risk factor for the development of a macular pucker is getting older, but there are some additional factors in play. (Learn More)

A macular pucker is different from a macular hole, (Learn More) and it is not the same thing as macular degeneration. (Learn More)

The damage associated with a macular pucker is typically not progressive. (Learn More) For most people, the symptoms are mild. (Learn More)

An optometrist will usually diagnose a macular pucker. (Learn More) In most cases, treatment will not be needed, or the use of corrective lenses will be sufficient. (Learn More)

If the symptoms of a macular pucker are severe, surgery may be recommended. (Learn More) On average, surgery restores 50 percent of lost eyesight, but the results can be variable. (Learn More)

eye anatomy

What Is the Macula?

The sense of vision requires physical energy from the environment to be translated in your brain to visual images. The area where this begins is the retina, the sensory membrane that lines the inner surface of the back of your eye. It has several layers.

In the center of the retina is an area called the macula. At the center of the macula, there is a small depression, the fovea, where photoreceptor cones are concentrated. This area is responsible for maximal visual acuity and color vision.

What Is a Macular Pucker?

A macular pucker refers to scar tissue that has developed in the macula. Scarring of the macula can lead to distorted vison or even blurry central vision, damaging the ability to see fine details in the center of your visual field.

The terms retina wrinkle, premacular fibrosis, and surface wrinkling retinopathy all refer to a macular pucker.

What Causes a Macular Pucker?

Most of your eye is filled with a thick gel-like substance that is known as vitreous humor or just referred to as the vitreous. It fills about fourth-fifths of your inner eye.

The vitreous humor contains millions of fibers that are connected to the retinal surface. As people get older, the vitreous humor slowly shrinks and moves away from the surface of the retina, leading to what is often referred to as a vitreous detachment.

This is a normal aspect of aging, and in most cases, it is relatively benign. In some cases, there can be damage to the retinal surface during this process.

The damaged area will heal and may leave a scar on the surface of the retina. When the scar tissue contracts, it leaves a wrinkle on the retina, which is often referred to as a pucker.

If the scar tissue is formed over the macula as this process occurs, you can develop a macular pucker. This macular pucker can affect your central vision.

closeup of old man and his right eye

Risk Factors for the Development of a Macular Pucker

Getting older is the major risk factor for the development of a macular pucker, as the process that forms a macular pucker is usually age-related. Some other risk factors include:

  • Swelling inside the eye.
  • Previous eye surgery or serious eye damage from an eye injury.
  • Problems with the vasculature in the retina that impairs blood flow.
  • A torn or detached retina.

Different Than a Macular Hole

A macular pucker is simply a wrinkle that occurs as a result of the above process, whereas a macular hole might occur when the process results in the virtuous humor actually separating part of the macula from the retina.

Of course, holes in the retina and macula can occur from other processes as well.

Not the Same as Macular Degeneration

Although the symptoms can be similar, a macular pucker is a different condition from  macular degeneration (also referred to as age-related macular degeneration).

Macular degeneration involves the breakdown of the macula, whereas a macular pucker occurs according to the process described above. Macular degeneration is a progressive disease and the most common cause of visual loss in people over the age of 60.

Not Progressive

A macular pucker usually develops in one eye, and the visual problems that may be associated with it remain relatively stable.

In some cases, one eye may be affected. Later, the other may be affected.

Businessman working at office desk, he is staring at the laptop screen close up and holding his glasses, workplace vision problems

Symptoms of a Macular Pucker

The symptoms can be variable and range from no visual problems at all to severe visual loss, although severe visual loss is rare.

Common symptoms include blurry vision, distorted vision, and straight lines appearing to be wavy. A gray area or blind spot in the center of vision may be present. Often, there will be difficulty distinguishing fine detail, such as reading small print.

Diagnosis of a Macular Pucker

Diagnosis is most often made by an ophthalmologist during a routine eye examination.

The ophthalmologist will dilate your pupils in order to view the inside of your eye and may take pictures using optical coherence tomography (OCT). By studying the pictures, the ophthalmologist can determine the source of the problem.

Treatment

In most cases, a macular pucker will not require treatment since the symptoms are typically mild. In some cases, the use of corrective lenses may be the only intervention needed, such as the use of bifocals to read small print.

Medications, eye drops, and nutritional supplements cannot help to remit the visual problems associated with a macular pucker. If the person’s vision is impaired to the point where it affects daily activities, surgery could be recommended, but in many cases, it is not.

An opthamologist is listening to the patient in an exam room.

How Does Surgery for a Macular Pucker Work?

The surgery to correct visual problems associated with a macular pucker is termed a vitrectomy.

In this procedure, the virtuous humor is removed and replaced with a salt solution. The scar tissue leading to the wrinkling of the macula is also removed.

There is some potential risk associated with any eye surgery, including:

  • Infections.
  • Bleeding in the eye.
  • A detached retina, where the retina separates from the back of the eye (rare).
  • Cataracts, or cloudy eye lenses.
  • Development of a new macular pucker in the future (rare).

Does the Surgery Work?

On average, about 50 percent of vision that is lost as a result of a macular pucker is restored by the surgical procedure, but results will vary. In most cases, full vision is not restored.

Recovery can take up to three months.

 

References

The Retina. (May 2017). MedlinePlus.

The Function of a Normal Macula. (July 2015). BrightFocus Foundation.

Macular Pucker. (April 2019). The Cleveland Clinic.

What Is the Virtuous Humor? (May 2017). WebMD.

Macular Pucker Causes. (August 2019). American Academy of Ophthalmology.

Facts About Macular Hole. (April 2012). National Eye Institute.

Facts About Age-Related Macular Degeneration. (November 2018). National Eye Institute.

What Conditions can OCT Help to Diagnose? (June 2019). American Academy of Ophthalmology.

Vitrectomy. (2016). American Society of Retina Specialists.