Q. My brother told me he has a macular pucker. Is this the same thing as macular degeneration?

First, a bit of biology ...

The lens in the front of your eye focuses light on the retina in the back of your eye. The lens is like the one in a camera, and the retina is like film. The space between the lens and retina is filled with the vitreous, a clear gel that helps to maintain the shape of the eye.

The macula is at the center of the retina in the back of your eye. The retina transmits light from the eye to the brain. The macula allows us to perform tasks that require central vision such as reading and driving.

A blurred area in the middle of your vision is a symptom of age-related macular degeneration, a leading cause of vision loss in Americans 60 years of age and older.

AMD comes in two forms wet and dry. Wet AMD occurs when blood vessels behind the retina start to leak and raise the macula. Dry AMD occurs when macular cells break down.

A macular pucker is scar tissue that has formed on the eye's macula. Like AMD, a macular pucker can blur central vision. Another symptom of macular pucker is seeing straight lines as wavy or broken.

People with a macular pucker might have difficulty seeing fine details and reading small print. They might also have a gray area in the center of vision, or even a blind spot.

Vision does not get progressively worse for most people with a macular pucker. Severe vision loss is uncommon. It is not unusual for someone to have puckers and still have normal vision. Usually, macular pucker affects one eye.

As we age, the vitreous slowly shrinks and pulls away from the retinal surface. In most cases, there are no serious adverse effects. However, sometimes there is damage to the retina's surface. As the damage heals, scar tissue is formed. When the scar tissue contracts, it causes the retina to pucker.

Sometimes macular pucker is caused by an injury or a medical condition, such as diabetes, that affects the eye. Macular puckers can sometimes form after eye surgery.

Macular pucker is also known as epiretinal membrane, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.

In many cases, the symptoms from macular pucker are mild, and don't require treatment. People usually adjust to mild visual distortion. In rare cases, surgery is required.

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