Center for Sight

Comprehensive Eye Care Center

Macular Diseases

In addition to Age Related Macular Degeneration (AMD) there are several other Macular Diseases that patients should be familiar with given their ability to significantly affect vision including a Macular Hole, Macular Pucker or Epi-Retinal Membrane, also called Vitreomacular Adhesion (VMR) and Central Serous Chorioretinopathy (CSCR).

This may occur for a number of reasons including eye injuries, inflammation inside the eye and most commonly, the normal aging process. As we age, the Vitreous gel in the back of our eye becomes more liquefied and often results in a Vitreous Detachment with associated floaters. Sometimes, when the Vitreous “pulls’ it can actually form a Macular Hole. Depending on whether a Macular Hole is through the full thickness or partial thickness of the retina common symptoms may include blurred central vision, distorted or “wavy” vision, difficulty reading or seeing fine detail even with glasses, a grayish area in central vision or even a central dark spot or “blind spot.”

This is also called Cellophane Maculopathy because it is the result of a cellophane-like membrane that forms over the Macula. It is typically a slow-progressing problem that affects the central vision by causing blur and distortion. As it progresses, the traction of the membrane on the Macula may cause swelling of the Macula. Macular Pucker is most often seen in people over 75 years of age and its exact cause is not really known, but it is thought to be associated with certain eye problems such as Diabetic Retinopathy, Posterior Vitreous Detachment, and Retinal Detachment as well as other conditions. Common symptoms may include blurred vision or even double vision that is noticeable even with one eye covered and distorted vision so that straight lines appear bent or “wavy.”

Central Serous Chorioretinopathy is a slight accumulation of fluid underneath the Macular area and in between certain retinal layers. Central Serous Chorioretinopathy usually, but not always, resolves without treatment after a few months with a full recovery of the diminished central vision. Serous means that the fluid is thin and watery. About one-third to one-half patients who have a Central Serous Chorioretinopathy has a recurrence after the first episode of the problem. The recurrence is within one year of the first episode, but relapses may occur up to ten years later. Common symptoms may include a minor blurring of vision, followed by various degrees of “metamorphopsia” or distorted vision, “micropsia” or the perception that objects are smaller than they actually are, “chromatopsia” or objects looking unusually colored and a shift of prescription toward farsightedness or hyperopia. Visual acuity may range from 20/20 to 20/200 and averages 20/30. In some patients the onset of symptoms is preceded or accompanied by migraine-like headaches.
Macular Hole, Pucker & Epi-Retinal Membrane and Central Serous Chorioretinopathy are easily detected through Visual Acuity testing in conjunction with an Amsler Grid Test, a dilated pupil examination of the Macula with an Ophthalmoscope and Slit Lamp High Magnification Fundus Lens, Optical Coherence Tomography (OCT) and sometimes an Intravenous Fluorescein Angiogram (IVF) or other specialized photographs.

Some Macular Holes seal by themselves and do not require treatment. In many cases however, surgery called Vitrectomy is necessary to close the hole and restore useful vision. During Vitrectomy, the Retinal surgeon will gently remove the Vitreous gel in order to eliminate any traction on the Macula. A gas bubble is then injected into the eye to place gentle pressure on the Macula and help the hole to seal. In many cases, patients enjoy functional vision after the bubble has been absorbed and the eye has healed.

In the past, Macular Pucker or Epi-Retinal Membrane or Vitreomacular Adhesion (VMA) that resulted in a considerable loss of vision, was treated by Retinal Surgeon performing a “membrane peeling.” However, it was generally recommended that a patient wait until the deterioration of vision causes a meaningful change to the patient’s lifestyle in order to justify the risk of this procedure. Today, advances make it possible for some patients to benefit from a one-time injection of a medication called Jetrea® into the vitreous gel. This medicine can break down the attachment between the gel and the retina. Dr. Kelly is able to detect VMA with an in-office OCT and determine whether Jetrea® injection might be of benefit, as Jetrea® is a proven non-surgical treatment for Vitreomacular Adhesion (VMA).

Most cases of Central Serous Chorioretinopathy resolve without any treatment. Although no medication has thus far proved effective in treating Central Serous Chorioretinopathy and the condition generally will resolve on its own, a beneficial effect of Laser Photocoagulation Treatment has been reported in several studies. It is believed that although direct photocoagulation of the leakage point does not improve the final level of vision, it can shorten the acute phase of the disease and also lower the recurrence rate to about one fifth of what would be expected without active treatment.