Macular Conditions

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Macular Conditions

The macula is the central part of the retina responsible for central vision. It contains the highest concentration of cone photoreceptor cells, which are essential for detailed tasks such as reading, recognizing faces, and driving. Conditions affecting the macula, including macular pucker, macular hole, and macular edema, vary in severity and can lead to permanent vision loss. Regular eye exams are essential for detecting problems early and protecting your vision.

Macular Condition Symptoms

Many macular conditions share similar symptoms, such as:

• Blurry or distorted central vision
• Straight lines that appear bent or wavy
• A blank or blind spot in the center of your vision
• Difficulty seeing in low light
• Colors that seem less bright or faded
• Objects appearing distorted

Macular Condition Risk Factors

Macular conditions aren't entirely preventable, but you can take steps to manage your risk. Common risk factors include:

• Being over 50
• Family history of macular conditions
• Diabetes
• High blood pressure
• Cardiovascular disease
• Poor diet
• Obesity
• Smoking

Macular Edema

Macular edema is a condition characterized by swelling of the macula, often occurring due to leakage from abnormal or damaged blood vessels in the eye. Various conditions can lead to macular edema, with diabetic retinopathy being the most common cause. When diabetic retinopathy causes macular edema, it’s called diabetic macular edema (DME).

Macular Hole

A macular hole is a small break or tear in the macula. This condition is often caused by tractional forces that occur during a posterior vitreous detachment (PVD), a normal aging process in which the vitreous gel in the eye decreases in quantity and thickness. In their early stages, some macular holes may heal on their own; however, they typically worsen and can lead to more severe damage. If left untreated, macular holes can result in progressive vision loss.

Macular Pucker (Epiretinal Membrane)

An epiretinal membrane, also known as a macular pucker, is a layer of scar tissue that forms on the surface of the retina. This condition is often caused by aging, as the vitreous gel inside the eye pulls away from the retina. Other potential causes include traumatic injuries, inflammation, retinal tears or detachments, cataract surgery, uveitis, and diabetes. While it typically affects only one eye, it can eventually impact both eyes.

Diagnosing Macular Conditions

A retina specialist can perform various tests to determine if a macular condition is present, such as:

• Eye dilation: During an eye exam, your doctor will use special drops to widen your pupil, allowing for a better examination of the retina.
• Ophthalmoscopy: A retina specialist may use an ophthalmoscope to shine a light into the eye and examine the retina.
• Optical coherence tomography (OCT): This non-invasive technique uses infrared light waves to capture detailed images of the retina.
• Fluorescein angiography: In this test, colored dye is injected into the bloodstream. This dye travels to the blood vessels in the eye, and a special camera captures images to identify any abnormalities in the retina.
• Indocyanine green angiography: Like fluorescein angiography, this test also involves an intravenous injection of dye. However, the type of dye used in this test absorbs infrared light, making it easier to visualize deeper blood vessels in the retina.
• Amsler grid test: The Amsler grid consists of a square with a grid pattern and a dot in the center, which can help identify problem areas in the field of vision.
• Ultrasound: This non-invasive imaging technique uses high-frequency sound waves to produce an image of the retina and macula.

Macular Edema Treatments

Anti-vascular endothelial growth factor (anti-VEGF) medications are a common treatment for macular edema. Anti-VEGFs are a class of drugs used to inhibit the growth of abnormal blood vessels in the eye and reduce leakage. Examples of anti-VEGF medications include Vabysmo, Eylea, Eylea HD, Cimerli, Lucentis, and Pavblu, which are administered via injection directly into the eye. Steroid injections can also help improve visual acuity.

Focal laser treatment, also known as photocoagulation, is used in certain cases of macular edema. This procedure utilizes a high-energy laser to close abnormal blood vessels, preventing further leakage.

Macular Hole Treatments

Macular hole treatment primarily involves vitrectomy surgery, in which tiny incisions are made in the eye, the vitreous gel is removed, and membranes on the macula's surface are often peeled away to relieve traction. Then, your retinal surgeon will put a sterile gas into your eye to keep pressure on the hole until it heals. You may have to stay in a face-down position for 1 to 7 days to keep the bubble in place so the hole can close.

If you have a small macular hole, your retina specialist may suggest monitoring it. In some cases, an early-stage macular hole will close on its own.

Macular Pucker Treatments

Treatment for a macular pucker depends on its severity and its impact on vision. Mild cases may only require monitoring, while moderate to severe cases are treated with vitrectomy surgery, in which microsurgical instruments are used to carefully peel the wrinkled scar tissue from the surface of the macula. Afterward, an air or gas bubble may be placed in the eye to help the retina heal and flatten properly. Your retina specialist may prescribe medication to manage swelling, but these medications can't repair the underlying pucker.