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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8489
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have been diagnosed with a macular pucker. I would an answer

Customer Question

I have been diagnosed with a macular pucker. I would an answer to the following questions:

1. How probable is it that I will develop a macular hole?

2. How will I know I develop a macular hole? (a little black spot?)

3. If I postpone the surgery until June 2012, when I retire, am I running a risk?

4. How many weeks should I book off work? (I am a part time English teacher.)

Margaret
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Customer :

Did you see my questions?

Dr. Rick :

Yes. I am a retina specialist and can answer all your questions on this topic....

Customer :

I don't know if you saw my questions about my macular pucker.

Customer :

That's great! I have been going crazy with stress.

Dr. Rick :

It is difficult to give you a specific odds value on when or if you will develop a macular hole from your macular pucker (epiretinal membrane). There are certain morphological features the make a hole formation more likely, however, many cases of macular pucker never go on to form a hole.

Customer :

What about my second question? How will I know if I am developing a macular hole?

Dr. Rick :

Macular pucker, however, does decrease vision (as you know ;), and can be progressive at times. In my practice I do not recommend surgery until the vision has fallen to the 20/40 (6/12) llevel, and that vision loss can be attributed to the macular pathology alone.

Dr. Rick :

Postponing the surgery does have risks and, unfortunately, since I can't see your retina, any number I give you for this "risk" would not be very valuable......

Customer :

How long does a person usually need to book off work for this surgery? I am a part time English teacher.

Dr. Rick :

However, let's assume for a moment that your vision has fallen below the 20/40 level and you have traction on your macua but no fluid formation or evidence of a pending hole on OCT and extended exam. If your retina specialist doesn't seem to have fits when you suggest holding off until after the school year, then I think you will be ok.

Customer :

You still haven't given me the signs of a macular hole.

Dr. Rick :

The recovery time varies on what has to be done during the surgery. You will most likely have a gas bubble left inside your eye after the surgery, and this bubble -- depending on what gas is used -- will last between 1 and 3 weeks. You may have to do special (face down) positioning during this time.

Dr. Rick :

Also, did the surgeon tell you that sometime in the near future you will get a cataract secondary to the macular pucker surgery?

Dr. Rick :

So, it would be least disruptive to your students if you could have the surgery during the summer. :)

Dr. Rick :

Oh....sorry about that. You wanted to know the symptoms you would notice if a hole were forming?

Customer :

Yes, he told me that I will need a cataract operation too.

Dr. Rick :

Early on you will notice blurry vision (this can be caused by other things too.) As it progresses you will notice straight line will look crooked and, then as the hole actually forms, you will notice problems reading, making out faces and they will be a "black hole" in the center of your vision that follows where you gaze like a rife sight. As the hole enlarges you will loose more and more vision until you become "legally" blind (in the USA that is less then 20/200 (6/600) vision). This doesn't cause "lights out" blindness as your side vision is never affected by this condition alone.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Are you still there?

Customer :

Yes. Thank you for your answers.

Dr. Rick :

My pleasure.

Dr. Rick :

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Expert:  Dr. Rick replied 3 years ago.
Best of luck to you. Try not to worry....it sounds like you are in good hands with the retina specialist you are working with :o)
Expert:  Dr. Rick replied 3 years ago.
oops. I just noticed you want to postpone surgery until June 2012......I thought you meant June 2011..

I'd think long and hard about putting off this surgery for 18 months. If you are going to do this have extensive discussions with your surgeon and, I would suggest, exams at least every 3 months or immediately if you notice any changes.

Sorry about screwing up that important piece of data :(

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5444 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest