Macular Pucker: Questions and Insights on Eye Health

Macular degeneration

Hello Dr.
He, I am #180537.
Thank you for your reply.
I had a follow-up appointment at the hospital three months ago, where the doctor performed an OCT and a fundus examination, but did not conduct a fluorescein angiography.
I was only informed that there is a macular fold.
I would like to ask the following questions:
1.
In this case, can we say that there is "no macular degeneration (dry or wet)," which is why the doctor did not arrange for further fluorescein angiography? The doctors at the medical center have many patients, and the consultation time is very short.
2.
I used the Amsler grid and did not notice any distortion, but the straight lines appear slightly wavy.
The doctor mentioned this is due to high myopia (left eye -1350 degrees, right eye -1800 degrees).
My current vision is 0.8 and 0.7 (sometimes it is 0.7 and 0.6).
There is a macular fold in my right eye, but the doctor has not mentioned the need for surgery.
What could be the reason for this?
3.
If there is macular degeneration, would my vision be worse?
I would greatly appreciate your response.
Thank you!

AA, 60~69 year old female. Ask Date: 2022/04/19

Dr. He Jianxian reply Ophthalmology

Generally, the criteria for considering surgery for macular folds include significant vision loss or severe distortion of vision, even to the point of having a gap in the central vision.
If these conditions are not present, regular monitoring is recommended, as surgery does not guarantee that symptoms will disappear or improve.
This is provided for your reference.
Dr.
He Jianxian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2022/04/19

More Info

Dear Patient,
Thank you for your inquiry regarding macular pucker and your eye health. I understand that you have several concerns, and I will address each of your questions in detail.

1. Macular Pucker and Absence of Macular Degeneration: It is indeed possible that your doctor concluded there is no macular degeneration (either dry or wet) based on the results of your OCT (Optical Coherence Tomography) and fundus examination. Macular pucker, also known as epiretinal membrane, is a condition where a thin layer of tissue forms on the surface of the retina, particularly in the macula, which can lead to visual distortions. The absence of macular degeneration suggests that the structural integrity of the retina is maintained, and this is likely why further tests, such as fluorescein angiography, were not deemed necessary. Fluorescein angiography is typically used to assess blood flow in the retina and can help identify conditions like diabetic retinopathy or wet macular degeneration, which may not be indicated in your case.

2. Amsler Grid Test Results: The Amsler grid is a useful tool for detecting visual distortions, particularly in the central vision. If you are noticing that straight lines appear slightly wavy or distorted, this can be attributed to the presence of a macular pucker. The fact that you do not see any significant distortion (or "curvature") in the grid is a positive sign, indicating that your central vision is relatively stable. However, the distortion of straight lines can be a common symptom of macular issues, especially in patients with high myopia (nearsightedness), as you have. High myopia can lead to changes in the shape of the eyeball and the retina, which may contribute to visual distortions.

3. Impact of Macular Degeneration on Vision: If macular degeneration were present, it could potentially lead to a decline in vision, particularly in the central field. Dry macular degeneration typically progresses slowly and may not cause significant vision loss initially, while wet macular degeneration can lead to rapid vision loss if not treated promptly. Given that your doctor has not indicated the presence of macular degeneration and has not recommended surgery, it suggests that your condition is being monitored and managed appropriately.
In summary, it seems that your current condition, macular pucker, is being observed without immediate intervention. It is essential to maintain regular follow-ups with your eye care provider, especially given your high degree of myopia and the presence of the macular pucker. If you notice any changes in your vision, such as increased distortion, loss of vision, or new symptoms, it is crucial to report these to your doctor immediately.

Additionally, while macular pucker can lead to visual disturbances, many patients adapt well to these changes. If you have concerns about your vision or the potential for surgery in the future, discussing these openly with your ophthalmologist can help alleviate anxiety and provide clarity on your treatment options.

Thank you for your questions, and I hope this information helps you understand your condition better. Please feel free to reach out if you have any more inquiries or need further clarification.

Best regards,
Doctor Q&A Teams

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