Macular Holes and Puckers

What are Macular Holes & Puckers?

The macula is a structure that helps form the central part of the retina. In this area, it has a high level of photoreceptor cells that sense light and send the messages back to the brain, which interprets the information as images. If you have certain conditions that damage the macula, you may experience loss of central vision and distortion of images. Two very common conditions that can greatly impact the macula include macular holes and epiretinal membranes.

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Macular Holes and Puckers Form

An epiretinal membrane is a thin line of scar tissue that forms over the retina. Scar tissue may be mild or severe, and in some cases, it tends to look like plastic coating of the outer retina during an eye exam. For more severe cases of macular pucker, it may cause the macula to wrinkle or look distorted. Compared to an epiretinal membrane, macular holes look like a micro-injury or hole that goes all the way through the macula. If you suffer from either of these conditions, you may experience a few common symptoms, including:


Epiretinal Membrane

  • Blurred central vision
  • Wavy or distorted vision, such as straight lines that appear to bend
  • Difficulty seeing detail
  • Trouble reading small print
  • A blind spot or gray area in your central vision

Macular Holes

  • Significant loss of central vision
  • Blurred vision and distortion
  • Occurrence of blind spots

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Generally, the most common reason for a macular pucker is because of age-related deterioration of the structures within the eye. As you start to age, the vitreous gel starts to shrink. If it shrinks enough, this gel can break away from its normal spot and create damage or swelling, which results in a macular pucker. In other cases, the vitreous gel does not detach without harming the delicate structure of the retina, which creates a macular hole. A macular pucker can also be caused by an injury or trauma to the eye, which causes scar tissue. Certain medical conditions, such as diabetes, may create a macular pucker because of the impact it has on retinal blood vessels.

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An epiretinal membrane is a thin line of scar tissue that forms over the retina. Scar tissue may be mild or severe, and in some cases, it tends to look like plastic coating of the outer retina during an eye exam. For more severe cases of macular pucker, it may cause the macula to wrinkle or look distorted. Compared to an epiretinal membrane, macular holes look like a micro-injury or hole that goes all the way through the macula. If you suffer from either of these conditions, you may experience a few common symptoms, including:


Epiretinal Membrane

  • Blurred central vision
  • Wavy or distorted vision, such as straight lines that appear to bend
  • Difficulty seeing detail
  • Trouble reading small print
  • A blind spot or gray area in your central vision

Macular Holes

  • Significant loss of central vision
  • Blurred vision and distortion
  • Occurrence of blind spots

Book appointment →

Generally, the most common reason for a macular pucker is because of age-related deterioration of the structures within the eye. As you start to age, the vitreous gel starts to shrink. If it shrinks enough, this gel can break away from its normal spot and create damage or swelling, which results in a macular pucker. In other cases, the vitreous gel does not detach without harming the delicate structure of the retina, which creates a macular hole. A macular pucker can also be caused by an injury or trauma to the eye, which causes scar tissue. Certain medical conditions, such as diabetes, may create a macular pucker because of the impact it has on retinal blood vessels.

Book appointment →

Treatment Options

Treatment is based on the severity of each condition. If an epiretinal membrane begins to affect everyday activities, a vitrectomy can be done using local anesthesia. While performing this procedure, fine instruments to gently remove the scar tissue from your macula. Afterward, you should experience relief from blurry and distorted vision once your eye starts to heal over the next couple of months.



For macular holes, we will monitor the severity of your condition because some holes may close without the need for professional treatment. However, for larger holes, you may need a a vitrectomy. Afterwards to reduce any pulling on the macula a temporary gas bubble in the eye is left to enable the hole to close.


In some cases an enzymatic injectable medication called Jetrea can be used to free up the traction that can lead to a macular hole and prevent the need for a vitrectomy. If your eye is a candidate for this approach you will be automatically provided the information about this alternative.

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