08 Oct When to Remove Macular Pucker
There are two indications for removing an epiretinal membrane, or macular pucker. An epiretinal membrane causes decreased vision and/or distortion. When either the vision or the distortion is noticed, I recommend macular pucker surgery The earlier the better.
Visual Acuity Not Good Enough
Too often, patients with an ERM/macular pucker are told their vision is “not bad enough.”
Patients with cataracts must wait until the vision is bad enough to qualify for cataract surgery. If the vision fails to meet certain criteria (usually 20/40 or worse), insurance will not cover the surgery.
This same criteria does NOT hold for retinal surgery, but too many retinal surgeons apply the same visual criteria to make the decision to consider surgery.
I feel the macular pucker should be removed once you (the patient) are aware of a difference in vision between the two eyes and your physician agrees the difference is due to the macular pucker.
Timing Macular Pucker Surgery
There is no guarantee how much your vision will improve with removal of the macular pucker. Unlike a cataract where the timing of surgery is not very important, timing macular pucker surgery is more critical. The better the vision at the time of surgery, the better the results.
For instance, if a patient develops a cataract, there is no impact on the visual prognosis depending upon the visual acuity at the time of cataract surgery. In other words, it doesn’t matter if we perform cataract surgery at 20/40 versus, say, 20/80. The visual improvement should be exactly the same.
This is not true of macular pucker surgery. The worse the vision is at time of surgery, the worse the visual results. Therefore, I advocate removal of the macular pucker as soon as possible. The timing of surgery should not solely be based upon the visual acuity.
In addition, OCT measurements show protracted thickening of the macula for over a year. It makes sense the remove the membrane to limit macular thickening.
Can’t Measure Distortion
While we measure vision with the eye chart, there is no way to measure distortion. Distortion is often present with an epiretinal membrane.
The distortion is caused by physical wrinkling of the retinal surface and in my experience is almost always improved with timely surgery.
What Does this Mean?
Macular pucker surgery can be extremely successful, the earlier surgery is performed. The decision to perform surgery should include information about macular thickening and distortion and not just visual acuity. Visual acuity, however, is the only variable that can be measured.
Whether you call it an epiretinal membrane or macular pucker, know that the sooner you choose to operate the more likely you’ll be happy with your results.