Retinal Tears and Membranes: Insights and Management

Retinal tear laser treatment

Dear Dr.
He,
Three months ago, during a routine eye examination for my high myopia, a peripheral retinal tear was unexpectedly discovered in my right eye.
The clinic physician performed laser photocoagulation at that time.
Recently, during a follow-up visit, a macular pucker was also noted.
Although the physician mentioned it is very mild, it still causes me concern.
Therefore, I have the following questions:
1.
How does a macular pucker (epiretinal membrane) develop, and what is the typical progression of the condition? (So far, I have not experienced any significant discomfort.)
2.
Are there any lifestyle interventions that can help slow the progression of this condition?
3.
I have noticed that after the laser treatment, whenever I watch TV or use the computer for a period of about thirty to forty minutes, or when transitioning from a bright area to a darker one, I see a faint blue light at the laser site (on the nasal side of my right eye) that lasts for about three to five minutes, whether my eyes are open or closed.
It disappears after I adjust.
What could be causing this? (If it were a precursor to retinal detachment, it should be sporadic, but it consistently occurs when moving from a bright to a dark area, which is puzzling.)
Thank you, Dr.
He, for your clarification.

Mr. Lin, 30~39 year old female. Ask Date: 2022/11/19

Dr. He Jianxian reply Ophthalmology

Macular folds are essentially a natural occurrence, likely caused by the traction between the retina and the vitreous due to vitreous degeneration.
Currently, there are no appropriate preventive or therapeutic measures available in clinical practice.
As for the blue light you see during the dark adaptation process, there is no adequate clinical explanation for this.
Director He Jian-xian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2022/11/19

More Info

Hello! Thank you for reaching out with your concerns regarding retinal tears and membranes. It’s understandable to feel anxious after discovering a retinal issue, especially given your history of high myopia. Let’s address your questions one by one.

1. What Causes a Macular Pucker (Epiretinal Membrane)?
A macular pucker, or epiretinal membrane, occurs when a thin layer of scar tissue forms on the surface of the retina, particularly in the macula, which is responsible for central vision. This condition can arise due to various reasons, including aging, retinal tears, or other retinal conditions. In your case, the laser treatment you received for the retinal tear may have contributed to the formation of this membrane. The progression of a macular pucker can vary; some individuals may experience minimal changes over time, while others may see a gradual worsening of symptoms. It’s important to monitor your condition through regular follow-ups with your eye care professional.

2. Lifestyle Interventions to Slow Disease Progression:
While there is no guaranteed way to prevent the progression of a macular pucker, certain lifestyle changes may help maintain overall eye health. These include:
- Regular Eye Exams: Keeping up with regular check-ups allows for early detection of any changes.

- Healthy Diet: Consuming a diet rich in antioxidants (found in fruits and vegetables) can support retinal health. Omega-3 fatty acids, found in fish, may also be beneficial.

- Protective Eyewear: Wearing sunglasses that block UV rays can help protect your eyes from further damage.

- Managing Systemic Conditions: If you have conditions like diabetes or hypertension, managing these effectively can help reduce the risk of further retinal issues.

3. Understanding the Blue Light Sensation After Laser Treatment:
The blue light phenomenon you describe after transitioning from bright to dim lighting could be related to several factors. After laser treatment, the retina may be more sensitive, and changes in light conditions can cause temporary visual disturbances. This could be due to the way your retina is processing light or a result of the laser treatment itself. It’s not uncommon for patients to experience visual anomalies after such procedures, but if these sensations persist or worsen, it’s crucial to discuss them with your eye doctor. They can assess whether this is a normal post-treatment effect or if further investigation is needed.

In conclusion, while the discovery of a retinal tear and subsequent epiretinal membrane can be concerning, many patients manage these conditions effectively with proper monitoring and care. Regular follow-ups with your ophthalmologist are essential to track any changes in your condition. If you experience any new symptoms, such as significant changes in vision, increased floaters, or flashes of light, seek immediate medical attention. Remember, early intervention can often lead to better outcomes. Take care, and I wish you the best in your journey towards maintaining your eye health!

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