By | February 2, 2015|

Macular pucker is a protracted visceral stress condition common to bungee jumpers.

Sorry, just kidding.

Macular pucker is actually an eye disorder – an anomalous facet of a normal happening.

When we are born the inside filling of our eyes is a clear but firm jelly called the vitreous. The vitreous is contained in a membrane which adheres to the inside wall of the eyeball. The tissue making up that wall is called the retina which contains all the sight nerves responsible for collecting visual information from the images that are focused on it.

As we age the jelly liquefies. At the same time the adhesion to the retina weakens. In the vast majority that is all that happens. By age 75 posterior vitreous detachment (PVD) is complete, and most are no worse-for-the-wear. The person notices a few more visual floaters, and life goes on.

But, in a chosen few the liquefaction gets ahead of the detachment, and there is tugging on the retina as the liquid sloshes around. If the traction is along the equator of the eye there may be retinal tears or hole which might lead to a detachment. If the traction is central near the more visually sensitive part of the retina called the macula one’s vision may suffer more immediately and more profoundly.

Occasionally traction on the macula is quite traumatic causing microscopic damage to this visually sensitive area. Sometimes macular holes develop, but in others the retina repairs itself with a fibrous membrane which contracts resulting in wrinkles on the macular surface. This is what’s called macular pucker – also referred to as cellophane maculopathy, epi-retinal membrane or pre-retinal membrane.

Usually vision changes are minimal and no treatment is needed. Occasionally surgery is recommended to prevent vision degradation. This intricate surgery prevents the vision from declining rapidly, but usually the vision in the affected eye is slightly reduced post surgically.

There is also good news on the horizon. With the advent of OCTs or ocular coherence tomography it is possible to follow traction on the macula from its inception. There has been some success with vitreolysis drugs that dissolves the proteins causing the vitreous adhesion. Currently vitreolytics are not recommended for asymptomatic macular pucker. The way to avoid vitreous traction, macular holes, and macular pucker is to have your eye doctor follow you with an OCT. This is especially true with those at greater risk for macular complications such as diabetics and those with age-related macular degeneration (ARMD).