September 2011 50 PLUS | News & Views Wrinkle on the Retina By Kamal Kishore, MD, Illinois Retina Institute I f you put your reading glasses on, cover one eye and look at a magazine or newspaper, does the print look smaller, larger or crooked compared to the other eye? If so, you might be having a wrinkle or pucker on the central part of the retina. The good news is, it can be repaired and at least 90% of patients can expect improvement in their vision. What is the Macula? The macula is the center part of our eye that is responsible for reading or “fine vision” such as watching TV, looking at details of a painting and color vision. It is only about ½ millimeter, or about the size of a pinhead. Any condition that affects the macula can have devastating effects on our ability to read or appreciate fine details in the world around us. Macular problems usually do not cause pain, redness or discomfort in the eye, and may remain undiagnosed for a long time because the other eye may compensate for the affected eye. It is therefore very important for everyone to use each eye by itself for a few minutes everyday. By covering one eye then the other, you’re making sure that each eye is seeing about the same as the day before. If there’s a change, prompt evaluation by an eyecare provider or a retina specialist is needed to diagnose the condition. What Causes a Wrinkle on the Macula? A wrinkle on the macula is caused by scar tissue that forms on the surface of the retina. It can happen either with aging, or from a variety of conditions such as diabetes, retinal tears, retinal detachments, eye injuries or inflammation. About 90% of cases of macular pucker are seen in perfectly healthy eyes and are believed to be due to aging. As the scar tissue shrinks, it pulls the surface of the macula towards its center. As a result, the center of the macula is shifted towards the region where the scar tissue is most marked. The macular area and surrounding retina may develop folds. Over time, the blood vessels in and around the macula get damaged and leak fluid causing swelling of the macula. What are the Symptoms of a Macular Wrinkle? Mild cases of macular pucker may not have any symptoms. Usually symptoms develop over months to years. Crookedness, waviness, or distortion of a straight line are initial symptoms. Vision may get blurry or decrease in the center with time. What can be Done? There is no medical treatment such as eye drops or pills for macular pucker. Surgical removal is the only treatment for this condition. Mild cases of macular wrinkle, where a patient has good vision and not much distortion in the center do not need surgery. Surgery consists of removing the scar tissue from the macula with special forceps Page 15 Figure 1: Macular wrinkle or pucker. Note thick white tissue covering the macula and causing formation of folds. Figure 2: Appearance of the same eye after removal of scar tissue. under a microscope under local anesthesia (Figure 1 and Figure 2). Most of our cases are performed with 25-g instruments that are thinner than the butterfly needle used to draw blood. The incisions are self-sealing eliminating the need for sutures. Surgery is therefore faster and more comfortable to the patient. Most patients can resume work within a week. If you would like more information on macular puckers or wrinkles, visit our website at www.IllinoisRetinaInstitute.com or call the office at 309-589-1880.