Eye Chat – From A Retinal Surgeon’s Perspective

Dr Lee Mun Wai - Retinal Surgeon’s Perspective
Dr Lee Mun Wai

Happy New Year everyone – I’d like to start the New Year by talking about conditions which affect the macula – the most important part of our retina.

What Is The Macula?

The macula is the most sensitive part of our retina responsible for 90% of our functional vision. If you remember, I had previously written about Age Related Macular Degeneration. There are other conditions which can cause similar loss of central vision which can have significant impact on our daily activities such as reading, driving and computer work.

Macular Pucker/Epiretinal Membrane

This is the formation of a “membrane” on the surface of the macula which is formed from the presence of scar tissue. There is gradual proliferation and contraction of the cells resulting in folds at the macula. Initially, affected individuals may not have any symptoms at all but as the condition worsens, one might notice visual disturbances ranging from generalised blurring of central vision, lines appearing wavy or distortion of central vision altogether.

This epiretinal membrane can be associated with retinal vascular diseases (e.g., diabetic retinopathy), retinal tears or detachment, eye injury, inflammation of the eye, after excessive laser treatment (to the retina for diabetic retinopathy) or eye surgery. They can also develop in persons over 50 years old with no apparent predisposing factors.

Macula Hole

This is a retinal break involving the macula. This condition is related to aging and usually occurs in persons over 50 years of age. As we age, the vitreous gel in the eye shrinks and pulls away from the retina. In some cases, when the gel pulls away, it can tear the retina. If this tear occurs in the peripheral retina, a retinal detachment can result. If this tear occurs at the macula, a hole is then formed. Macular holes can also result from eye injury, macular pucker, high myopia and diabetic retinopathy.

The symptoms of a macular hole would include distortion of central vision, loss of central vision and in rare cases, if a retinal detachment ensues, total loss of vision.


Macular pucker and macula holes can be easily diagnosed by your ophthalmologist if he/she performs a retinal examination after dilating your pupils. Not every case requires treatment as it is usually not a rapidly progressive condition and to monitor this, a scan of the macula area with an Optical Coherence Tomography (OCT) machine is often necessary. This scan provides very detailed information about the different structures at the macula and shows the extent and size of the macular pucker/hole.


Treatment of these conditions is surgical. A procedure called a vitrectomy would have to be performed by a retinal specialist and the “offending” membrane peeled off. This surgery is somewhat more complex than cataract surgery, different instrumentation is required, surgical time is longer and recovery is not as quick as in cataract surgery. Nevertheless, it is necessary in many cases and is the only treatment available up to now.

For more information about retinal diseases or other aspects of eye care, please visit my blog at http://www.lec.com.my/youcare-eyecare.


For more information, contact:  Lee Eye Centre Ipoh

Tel: 05-254 0095 or email: enquiry@lec.com.my. Website: www.lec.com.my