Macular Conditions

Macular Condition Care in Chattanooga, Knoxville, and the Tri-Cities Region

While the retina is responsible for enabling sight, the ability to perceive straight-ahead, fine images, and engage in close-up activities such as reading is specifically attributed to the macula, which is the yellow-pigmented center of the retina. The structure of the macula is susceptible to various disorders, including the development of macular holes and epiretinal membranes / macular puckers. At Southeastern Retina Associates, we specialize in the diagnosis and treatment of various macular conditions, offering a range of surgical options to address these issues.

Macular Conditions

Macular Hole

A macular hole is a break that occurs when the macula is stretched or pulled, often due to a normal aging process called posterior vitreous detachment (PVD). PVD targets the vitreous gel that fills the eye, causing it to shrink, liquefy, lose viscosity, and become sticky. Portions of the diminished vitreous can cling to the retina, tugging on the macula via a process called vitreomacular traction (VMT), eventually leading to hole formation. Fluid can enter through the hole, pooling beneath the retina and forming a surrounding band. Macular holes can also be caused by traumatic eye injuries, undergoing laser treatment, being severely nearsighted, macular edema, and diabetic eye disease.

Macular Puckers & Epiretinal Membranes

Macular puckers, also known as epiretinal membranes, are thin, semi-transparent scar tissue that manifests over the macula. After the membrane develops and spreads, it may contract, leading to the retina wrinkling. PVD is often a contributing factor, as the sticky vitreous tugs on the retina, potentially damaging macular tissue. Further harm may occur when cellular debris collects in the vitreous. Puckers are also linked with underlying problems, like eye disease or trauma. While central vision may be distorted, peripheral vision remains, with total blindness unlikely.

Symptoms of Macular Conditions

Typically, with macular holes and puckers, you may experience central vision issues, sparing peripheral vision, with little risk of total blindness, especially if your other eye is unaffected. Vision is more likely to decline from the inside out, as the outside border remains intact.

With macular holes, in particular, straight lines may appear distorted or wavy. The missing retinal tissue in the holes’ centers can also result in blind spots. With macular puckers, cloudy or blurred vision and other effects can occur, although they may not be immediate. The symptoms’ duration isn’t clear-cut, as patients often rely on their unaffected, better-seeing eyes to compensate. This may result in problems with depth perception, leading to issues performing fine motor tasks with the stricken eye. In rare circumstances, macular puckers can progress into macular holes.

Macular Condition Risk Factors

Aging is a prime risk factor for both macular holes and puckers. Other risk factors include:

• Laser eye therapy or eye surgery, such as for cataracts
• Severe nearsightedness
• Retinal tear or detachment
• Uveitis, inflammation within the eye
• Diabetic retinopathy
• Severe eye injury

Diagnosing Macular Conditions

Macular holes and macular puckers, much like other retinal disorders, are generally diagnosed during a retinal testing exam, which may include tests such as optical coherence tomography (OCT) or fluorescein angiography. These diagnostic tests determine the presence and characteristics of macular holes and puckers. If you are diagnosed with a macular condition, your doctor may recommend that you use an Amsler grid daily so that you can monitor any vision changes at home. An Amsler grid is a simple tool consisting of black lines against a white background with a small dot in the center.

Treatment for Macular Conditions

In many cases, macular holes and puckers may not lead to vision problems, necessitating only regular monitoring. Your retina doctor may recommend a vitrectomy to remove the vitreous gel partially or fully and prevent macular traction in the case of macular holes. For macular puckers, updating your eyeglasses or prescription may be sufficient.

If central vision deterioration affects close-up activities, a vitrectomy may be necessary. Depending on membrane severity, a membranectomy may accompany the procedure. This involves peeling the innermost layer of the retina, the internal limiting membrane, to ensure complete relief of macular hole traction. Proven safe and effective, 80% to 90% of patients typically experience visual improvement with this procedure.

Macular Condition FAQ FAQs

• How serious is a macular hole?

  A macular hole is a serious eye condition affecting central vision. If left untreated, it can lead to significant visual impairment. However, with timely diagnosis and appropriate intervention, such as vitrectomy surgery, the outlook for recovery is generally favorable. Regular eye examinations are crucial for early detection and management to minimize the impact on vision.

• What is the recovery process following surgery for macular conditions?

  Following a macular hole or pucker procedure, particularly a vitrectomy, recovery typically spans several weeks. Most macular holes effectively close after a single procedure, resulting in significant improvement in blurred vision and distortion for most patients. Residual visual loss or symptoms may persist to some extent. The procedure's success hinges on factors like the hole's cause, duration, baseline vision, stage, and severity. While cataracts may develop post-surgery, rarer complications, including bleeding, infection, retinal tears, and detachment, can be treated.

• What is a membranectomy, and does it benefit epiretinal membranes?

  If you have a macular pucker, a vitrectomy may be needed. Depending on membrane severity, another procedure, a membranectomy, involves peeling the retina's innermost layer, the internal limiting membrane, to relieve traction from the macular hole. Proven safe and effective, 80% to 90% of patients typically experience visual improvement with this procedure.