What is Macular Pucker?

Macular pucker affects approximately 10 percent of people, particularly men and women over the age of 50. Based in the center of your retina, the macula is responsible for the part of your vision that allows you to see straight ahead. As you read the text on this page, you are using your macula. When the retinal surface forms an extra layer of tissue and contracts, distorting the retina, it is known as a macular pucker. They look like a piece of scotch tape and can distort the central vision. If you start to notice this, you should see a doctor for macular pucker as soon as possible.

What is Age-Related Macular Degeneration (AMD)?

Age-Related Macular Degeneration (AMD) is a disease, which causes visual loss in patients over the age of 50. The vision loss is painless, usually gradual and not severe, but can be variable among patients. Macular degeneration is named for the macula, the part of the retina responsible for central vision. Peripheral vision is usually not affected by macular degeneration and often, this illness will go unnoticed until a patient engages in a task such as driving or reading, in which central vision is crucial. As the term “degeneration” implies, the illness becomes more noticeable over time and tends to get worse with or without treatment. Macular degeneration typically affects adults over 65 and the main risk factors for the disease are increasing age and genetics (family history of macular degeneration). Smoking, high cholesterol and hypertension are also risk factors. This disease does not cause total blindness and most macular degeneration patients can see well enough to care for themselves.

What is Retinal Tear and Retinal Detachment?

Retinal detachment is treatable when caught early. Treatment may or may not involve an in or outpatient surgical procedure. In cases that do require surgery, a patient may require immediate attention or the procedure may be postponed for days or even weeks depending on the condition’s severity. Two major retinal detachment surgeries include: Vitrectomy: In this procedure, the surgeon removes the vitreous jelly, which has pulled on the retina and caused retinal detachment. Usually, the doctor then replaces the fluid with a gas bubble, which the eye, in time, will absorb and replace with its natural fluids. Doctors may recommend this surgery in instances where:

What is Diabetic Retinopathy?

Diabetic retinopathy is a condition where high blood sugars damage the blood vessels in the retina (the retina is the layer of cells in the back of the eye that transmit light to the brain to form images). There are two main types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

What is Retinal Vein Occlusion (RVO) and Macular Edema?

The retina is the light-sensing layer of cells that lines the inner wall of the back of the eye. The retina converts light into signals that are sent to the brain where they are recognized as images. What is Retinal Vein Occlusion? Your retinas require a rich supply of oxygenated blood. This blood is carried to the retina from the heart through arteries, while veins carry deoxygenated blood from the retina back to the heart via the optic nerves. The arteries that transport oxygen to your retina may stiffen and thicken over the years, especially in people with diabetes, cardiovascular disease, high blood pressure and high cholesterol. The retinal arteries and veins are close to the optic nerve and cross various locations on the retina’s surface. As arteries thicken, they can compress the retinal vein at artery-vein crossing points or in the optic nerve. This compression can be so severe that the veins become constricted and thus blood flow to the heart is reduced. The blood then backs up into the retina not unlike the water in a clogged bathtub. The pressure of blood in the veins causes swelling (called macular edema) and bleeding in the retina.

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Age-Related Macular Degeneration (AMD)

California Macular Degeneration Specialist

Age-related macular degeneration (AMD) is a disease of aging that is:

common
gradual
progressive
painless
characterized by deterioration of the macula, a small area in the center of the retina

When unmonitored and untreated, AMD results in vision loss, especially for daily tasks like driving, reading, etc. With appropriate monitoring and timely treatment, most patients can maintain vision for years to come.

Age-related macular degeneration affects the macula region of the retina.

What is the Retina?

If the eye were a camera, the retina would be the film of that camera
The retina is a thin sheet of nerve cells that lines the inside back wall of the eye
Light travels through the eye and ultimately reaches photoreceptors, the light-sensitive cells in the retina
The signal from the photoreceptors then travel along the optic nerve to the brain, where the signals are interpreted as vision

retina2

What is the Macula?

The macula is the center region of the retina
The macula is responsible for high detail vision, central vision, reading, etc. The rest of the retina is responsible for peripheral vision.
AMD affects the macula, and in turn, results in decreased vision for tasks like reading, driving, recognizing faces, etc.

What are the Symptoms of AMD?

What are the Types of AMD?

There are 2 types of AMD

Dry age-related macular degeneration (dry AMD)
- Milder, earlier, more common form of AMD
- Age-related deposits accumulate in the retina, causing mild to moderate vision symptoms
- In late stages, tissue loss (called “atrophy” or “geographic atrophy”) can occur, resulting in severe vision loss
- The dry form can convert to the wet form at any time
Wet age-related macular degeneration (wet AMD, also known as exudative AMD)
- Wet AMD has all the features of dry AMD, plus:
  - New blood vessels that grow under and/or into the retina. This abnormal blood vessel growth is called “choroidal neovascularization.”
  - The abnormal blood vessels leak fluid or blood into the retina, thus “wet” AMD
  - Vision decrease may occur gradually or it can occur suddenly, with potentially vision loss

Combined+drusen+photo+and+OCT — Left image: Photograph of the right eye of a patient with dry AMD with yellow drusen deposits visible under the retina (red arrow). Right image: Optical coherence tomography (OCT) scan of the same patient shows the retina in cross section through the area of drusen (red arrow).

Combined+image+of+dry+amd+w+GA — Left image: Photograph of the left eye of a patient with dry AMD with area of “geographic atrophy” (yellow patch, red arrow). Right image: Optical coherence tomography (OCT) scan of the same patient shows the retina in cross section and tissue loss is visible in the area of geographic atrophy (red arrow).

Combined+wet+AMD+image — Left image: Photograph of the left eye of a patient with dwet eye with pigmetary changes (dark spots) visible. Right image: Optical coherence tomography (OCT) scan of the same patient shows the retina in cross section. There is an abnormal blood vessel growth (red arrow), which is leaking fluid under the retina (dark black cleft, yellow arrow).

What are Risk Factors for AMD?

Older age
Female
Caucasian
Family history
Smoking
High cholesterol
High blood pressure

How Does My Doctor Diagnose AMD?

Dilated retinal examination
Optical coherence tomography (OCT) scan: painless photograph that provides a cross-sectional scan through the macula so that microscopic details of the macula can be discerned

Getting an OTC — Top image: An optical coherence tomography (OCT) scan is a safe and painless imaging test that allows for examination of microscopic changes in the retina. Bottom left image: Right eye retina. Left image: OCT-scan through a single slice of the retina shown in the left image. The OCT is normal. The downward dip in the retina is the normal foveal depression.

In some patients:

Fluorescein angiography
- A dye is injected into the arm, from which to travels through the blood to the eye.
- Photographs are taken of the eye which map out all the blood vessels and blood flow in the retina
- This test identifies areas of blood flow loss as well as areas of new blood vessel grown (neovascularization)

FA+procedure — Left image: A fluorescein dye is injected into the vein in the arm. The dye travels through the bloodstream to the eye and then photos are taken (middle image). Right top and bottom images: The resulting angiogram highlights blood vessels and blood flow in the retina. In this image, there is a choroidal neovascularization membrane (white area in middle of bottom image) characteristic of wet AMD.

How is Dry AMD Treated?

Patients with dry AMD are monitored for conversion to wet AMD (for which there is treatment, see below).
AREDS2 vitamins (over the counter) may reduce progression of dry AMD and thus may be recommended
An “Amsler grid” is provided to allow patients to monitor for subtle vision changes between appointments
If there is geographic atrophy present, treatments are now available to slow down the progression of geographic atrophy (Syfovre, Izervay)

How is Wet AMD Treated?

Wet AMD is treated with injections of medications (anti-VEGF medications) that block VEGF.
VEGF causes abnormal blood vessel growth and blood vessel leakage; thus, anti-VEGF agents reduce leaking from abnormal blood vessels and can even promote regression of abnormal blood vessels
There are several anti-VEGF medications
- Avastin (bevacizumab)
- Lucentis (ranibizumab)
- Eylea (aflibercept)
- Vabysmo (faricimab), which not only blocks VEGF but also blocks Ang2 which is involved in AMD
- And others

What is it Like to Get Intravitreal Injections in the Eye?

The injections are given into the eye (intravitreal injections) in the office, after drops are given to numb and clean the ocular surface.
The medications last several weeks in the eye.
- Some patients require injections every month to control the disease, while others require injections less often, and yet others are able to eventually stop injections and monitor for recurrence.
- The treatment is individualized to each patient’s disease and response to treatment.
There are new drugs in the research pipeline that may last longer.

Patient Reviews

    
 
 
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   Roz Cole 
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 Trustindex verifies that the original source of the review is Google. Prompt & efficient.
  
 
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   Andy Shields 
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 Trustindex verifies that the original source of the review is Google. Professional office
  
 
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   PBofLN 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. I’ve been seeing Dr. Eifreg for a number of years now since he reattached my almost completely detached retina. He is an excellent doctor and surgeon. He never rushes me through my appointments and answers any questions I have. In addition, he is personable, can be funny, and is just a very nice man. From the front office staff to the assistants who check your eyes before you see Dr, Eifreg, they are all extremely efficient. I am now on yearly maintenance visits and they always contact my insurance for a referral before my appointment. I also always get an appointment reminder text or call. But what’s really amazing - This is a VERY busy practice and I am always seen on time or within maybe 15 mins of my appointment time. I don’t know how they do it, but this office runs like a well-oiled machine. And to top it off, EVERYONE is helpful, cheerful and has a “service” attitude at all times. I know this all sounds too good to be true, but it is honestly the case at Dr. Eifreg’s office. I am so glad my primary doctor sent me to Dr. Eifreg for my retina surgery. Of course the most important thing is that he’s an excellent surgeon, but it’s also wonderful that he runs a great office with an exceptional staff!
  
 
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   Deb Hanna 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Everyone at this office was very friendly.
The office was definitely busy but It was my first visit there and they still made me feel welcome and cared for.
Dr Gupta explained my condition so I could easily understand it and was very pleasant to talk with. I had to leave another Retina group because of an insurance change but think the transition to this new group went smoothly and will be a good fit for me moving forward.
  
 
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   Diane Bridges 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Very efficient and pleasant staff. Excellent doctor. Have been going to him for nine years. I would never change doctors!
  
 
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   PriscillA Schultz 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. everyone is very kind and thorough in the office. The doctor is great and was on time.
  
 
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   rebecca peyrefitte 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. This experience at this Dr office was outstanding. All the staff was very supportive and efficient. I was very pleased with the service I was given.
  
 
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   Deborah Misserville 
 0 days ago
 
 
 Trustindex verifies that the original source of the review is Google. The Best!  Professional and knowledgeable
of current medical technology and techniques.  And equally as important...kind and caring Dr and staff!
  
 
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   Juli White 
 4 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Efficient and considerate of the patient’s time, friendly and most importantly, competent - everything you’d want from a doctor’s appointment!
  
 
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   Kelvin Kitaoka (Kazu) 
 5 days ago
 
 
 Trustindex verifies that the original source of the review is Google. Great Organization and very methodical with service and procedure. Dr. Chen is the best in Retina eye care.. hands down.