Macular Conditions

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Macular Conditions

The central area of the retina is known as the macula. As the primary mechanism behind central vision, the macular tissue is comprised almost entirely of cone cells, which control the eye’s ability to see fine details and color. When the macula is damaged, it can have an effect on our ability to perform a wide range of visual functions, such as reading, driving, and recognizing faces.

Macular Hole

A macular hole is a type of macular condition that is common in older adults. It is characterized by tissue defects in the macular layers. Common symptoms of macular holes include blurred and distorted vision. Although some patients are able to pinpoint the exact moment the hole developed, most patients experience the onset of symptoms in a more gradual manner. Other patients may not experience symptoms at all. In these cases, macular holes are only discovered during a routine eye exam. As the macular hole expands, it can cause scotomas (i.e. blind spots) in the patient’s central field of vision.

The severity at which a patient’s visual acuity is affected is determined by the size, location, and stage of the macular hole. For example, patients may retain good visual acuity if they have small, eccentric macular holes, or if the macular hole has only reached partial thickness. However, a macular hole that develops to full thickness will generally range in a sharp decline in visual function.

A full-thickness macular hole can be observed with direct ophthalmoscopy and retinal imaging. It is often recognized by a well-defined round or oval lesion in the macula with yellow-white deposits at the base.

Causes of Macular Holes

There are several factors that can cause a macular hole, including:

• Vitreomacular traction: a condition in which the vitreous jelly tugs at the macula
• Foveal schisis: a condition associated with high myopia (i.e. extreme nearsightedness) in which the layers of the retina separate
• Traumatic injury: approximately 6% of macular holes are caused by contusion injuries
• Prior retinal detachment: in a small number of cases, retinal detachments that impact the macula can sometimes lead to the formation of a macular hole after undergoing a scleral buckle procedure

Treatment of Macular Holes

Traditionally, macular holes are treated with vitreoretinal surgery, especially in cases of full-thickness macular holes. In surgery, three small ports are placed into the eye. A vitrectomy, or removal of the vitreous, is performed. Once this is completed, a dye is used to stain a small membrane called the internal limiting membrane (ILM). It is carefully removed. A gas bubble is then placed into the vitreous space. After the surgery, the patient must perform face-down positioning for up to one week. There is equipment available to assist you with this difficult task.

Macular Pucker / Epiretinal Membrane

Macular pucker, also known as epiretinal membrane, occurs when abnormal cells grow over the macula. This leads to blurry or distorted vision. We diagnose this condition and assess the severity with a dilated eye exam and retinal imaging.

Causes of Macular Puckers

Most macular puckers are caused by age-related factors but can occur at any age. In many cases, there is no obvious cause. However, there are several risk factors that can increase your chances of developing an epiretinal membrane, including:

• Vitreous detachment
• Retinal tears and detachments
• Traumatic injury to the eye
• Eye surgery
• Uveitis

Treatment of Macular Puckers

Often, patients are asymptomatic and the condition is monitored. However, if the distortion or blurry vision begins to worsen or significantly impact a patient’s life, then surgical removal is an option.

In surgery, three small ports are placed into the eye. A vitrectomy, or removal of the vitreous, is performed. Once this is completed, the membrane is removed carefully with small forceps. Removal of the membrane allows the macula to “relax” back into position, often improving distorted vision. The recovery period from this surgery is typically 1-2 weeks.

Vitreomacular Traction (VMT)

Vitreomacular traction (VMT) occurs when the vitreous gel inside the eye pulls on the macula. In an average, healthy eye, the vitreous gel fully adheres to the retinal tissue. However, as we age, the vitreous begins to diminish in quantity and viscosity, making it more liquidy and less sticky, causing it to shrink away from the retina. It may even completely detach itself from the retinal tissue, which is known as posterior vitreous detachment (PVD). However, in some patients, some of the vitreous gel may remain adhered to the macular area, tugging on the macula as it tries to pull away. Although this isn’t painful, it can cause distorted or blurry vision and eventually lead to vision loss, especially if left untreated.

Causes of Vitreomacular Traction

Aside from age, VMT is more likely to occur in patients with certain eye conditions, including diabetic retinoapthy and age-related macular degeneration (AMD). It is also sometimes associated with retinal vascular occlusive diseases.

Treatment of Vitreomacular Traction

VMT sometimes does not have a significant effect on a patient’s vision. In these mild VMT cases, there may be no recommended treatment path beyond the patient self-monitoring their symptoms and attending follow-up visits with their doctor. Self-monitoring typically involves the use of an Amsler grid, which helps people detect changes in their vision and whether they are experiencing visual distortions.

In more advanced cases of VMT, vitrectomy surgery may be recommended. During the vitrectomy procedure, the retina specialist will remove the vitreous gel from the eye, which will alleviate the traction.