The Difference Between Macular Degeneration and Macular Pucker

Last updated: March 2022

Macular degeneration and macular pucker both impact the macula. However, they are 2 different conditions.

The macula

The macula sits at the center of the retina, the light-sensing part of the eye that helps us see. Macular degeneration involves the breakdown of or damage to the macula typically associated with age (dry macular degeneration) or with the growth and leakage of abnormal blood vessels (wet macular degeneration). In contrast, macular pucker is the result of scar tissue on the retina.1,2

What is macular pucker?

The main feature of macular pucker is scar tissue on the retina. This causes the macula to wrinkle or pucker. Like macular degeneration, the risk of macular pucker increases with age. Macular pucker can cause wavy, blurry, or distorted central vision. This is similar to macular degeneration. However, the vision loss in macular pucker is generally more stable and less progressive, although personal experiences can vary.1,2

Some other common names for macular pucker include:1,2

  • Retina wrinkle
  • Premacular fibrosis
  • Cellophane maculopathy
  • Epiretinal membrane

What causes macular pucker?

There are several different ways a person can develop scarring on their macula. One of the most common causes of macular pucker relates to vitreous detachment. Vitreous fluid is the jelly-like substance in the eye that helps give it its shape. It connects to the surface of the retina in the back of the eye.1,2

Over time, the vitreous pulls away from the retina and shrinks. This is a normal part of aging and is called vitreous detachment. Vitreous detachment is 1 of the processes that contributes to vision changes with age, including the development of floaters. When the vitreous pulls away from the retina, it can cause minor damage. This damage to the retina can lead to scarring and macular pucker. This is different from direct damage to the retina and its light-sensing cells, which causes macular degeneration.1,2

Other risk factors for macular pucker besides aging include:1,2

  • Past eye trauma
  • Eye surgery
  • Problems with the blood vessels or blood flow in the eye
  • Other eye conditions including retinal detachment or retinal tear

Diagnoses

Diagnosing macular pucker involves a full eye exam to assess the retina at the back of the eye. An ophthalmologist (eye doctor) can diagnose both macular pucker and macular degeneration, and tell the difference between the 2. Your eye doctor will take pictures of your retina using optical coherence tomography (OCT). Your eyes will be dilated so the exam and images can be taken. When your doctor reviews these images, they can determine the underlying cause of any vision changes.1,2

Treatment

Most commonly, people with macular pucker do not need treatment. Their vision loss is mild, and their eyes will adjust over time. Corrective lenses (glasses) may be helpful in adjusting to changes in vision. Ultimately, there are no medicines, eye drops, vitamins, or supplements that can directly treat the vision changes related to macular pucker.

Macular degeneration treatment

This is different from macular degeneration, since medicines, laser procedures, and nutritional supplements may be helpful in slowing the progression of vision loss.
1,2

Surgery for severe macular pucker

Sometimes, the vision changes from macular pucker resolve on their own if the scar tissue detaches from the retina or clears up on its own. Although many will have mild vision loss that is manageable, some may have more severe symptoms. When this happens, surgery or eye injections may be helpful.1,2

The most common surgery used for people with severe vision loss due to macular pucker is called vitrectomy. This involves removing the detaching vitreous fluid from the eye and replacing it with a salt solution. It may also be possible to remove the piece of scar tissue that is on the retina and causing it to pucker. Typically, people who undergo vitrectomy will not be able to tell the difference between the salt solution in their eye and their original vitreous fluid.1,2

However, surgery for macular pucker is not always a complete fix. It is common for those receiving surgery to only have 50 percent of their lost sight restored. It may also take several months and regular eye drops to heal from the procedure. Surgery may also increase a person’s risk of developing other complications later on, like retinal detachment (where the retina detaches from the eye itself) and cataracts.1,2

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