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.

California Retinopathy of Prematurity

Are you looking for a retinopathy of prematurity specialist in Orange County? At Retina Associates of Orange County, our retina practice is grounded in more than two decades of clinical experience and fellowship training from the University of California San Diego, Columbia University, and other leading institutions.

When a baby is born before the retina has finished developing, the blood vessels that supply the back of the eye can grow abnormally in the weeks that follow. Retinopathy of prematurity is one of the leading preventable causes of childhood blindness, and timely screening in the neonatal period is the most reliable way to detect it before permanent damage occurs. Our board-certified retina physicians evaluate and treat ROP at offices in Laguna Hills, Newport Beach, Santa Ana, and Huntington Beach, and we coordinate closely with neonatal intensive care teams across the region. A California retinopathy of prematurity specialist can assess your baby’s retinal development and recommend treatment if the condition is progressing.

Retinopathy of Prematurity Specialist in California, CA

The retina develops its blood vessel network during the final weeks of pregnancy. In babies born prematurely, particularly those born before 31 weeks of gestational age or weighing less than three pounds at birth, that process is incomplete. After delivery, the immature retinal vessels can respond to changes in oxygen levels by growing in a disorganized pattern. If left unchecked, these abnormal vessels can bleed, scar, and ultimately pull the retina away from the back of the eye.

A retina specialist trained in pediatric retinal disease is essential for identifying and managing this process. The staging, treatment decisions, and follow-up intervals involved in ROP require clinical judgment that goes beyond a general pediatric eye exam. Our California physicians have the training and imaging capabilities to evaluate at-risk infants and intervene when the disease threatens vision.

Retinopathy of Prematurity Services We Offer in California

Retinopathy of prematurity ranges from mild, self-resolving disease to sight-threatening stages that require urgent intervention. Our retina specialists provide the following services to families and referring neonatal teams across California.

ROP screening examinations. Screening begins in the NICU or shortly after discharge, typically when the infant reaches 31 weeks postmenstrual age or four to six weeks of chronological age, whichever comes later. We perform dilated fundus exams to assess retinal vascular development and classify the stage, zone, and presence or absence of plus disease.
Laser photocoagulation treatment. For infants with severe ROP that meets treatment criteria, laser therapy applied to the peripheral avascular retina is the standard intervention. The laser reduces the stimulus for abnormal vessel growth and has been shown in federally funded clinical trials to preserve vision in high-risk infants.
Anti-VEGF injection therapy. Intravitreal injections that block vascular endothelial growth factor can halt abnormal vessel growth in the most posterior and aggressive forms of ROP. This approach has become an important treatment option, particularly for zone I disease where laser alone may not be sufficient.
Surgical intervention for advanced ROP. Stages 4 and 5 retinopathy of prematurity involve partial or total retinal detachment. When the retina begins to pull away, vitrectomy or scleral buckling surgery may be necessary to attempt reattachment and preserve whatever vision is possible.
Optical Coherence Tomography imaging. Advanced imaging allows our physicians to document retinal vascular development in detail, track changes between visits, and share findings with the referring neonatal team or pediatric ophthalmologist. This documentation is critical for treatment decisions and long-term records.
Long-term retinal monitoring. Even after ROP resolves, children born prematurely face a higher lifetime risk of myopia, strabismus, amblyopia, and retinal detachment. We provide ongoing retinal surveillance to catch late complications early.
Coordination with NICU and pediatric teams. ROP care does not happen in isolation. We communicate directly with neonatologists, pediatricians, and pediatric ophthalmologists to coordinate screening schedules, discuss treatment timing, and transition care smoothly as the infant moves from hospital to outpatient follow-up.

Why Choose Retina Associates of Orange County for Retinopathy of Prematurity in California?

Coordinated Care from the NICU Forward

Treating retinopathy of prematurity well requires a physician who understands both the disease and the fragile clinical context of the patients who have it. Dr. Desmond McGuire completed his medical education at the Sackler School of Medicine at Tel-Aviv University, an internship at Columbia University College of Physicians and Surgeons, residency at St. Vincent’s Hospital and Medical Center in New York, and a retina fellowship at the Shiley Eye Center at the University of California, San Diego. That training included exposure to the full range of retinal disease, from premature infants in the NICU to adults with complex surgical conditions. Dr. Mrinali Gupta and Dr. John C. Hwang are both board-certified retina specialists who contribute to the practice’s pediatric and adult retinal care across Orange County.

All three physicians are members of the American Society of Retina Specialists and the American Academy of Ophthalmology. With offices in Laguna Hills, Newport Beach, Santa Ana, and Huntington Beach, our practice provides outpatient retinal care close to the hospitals and NICUs that serve Southern California’s premature infant population.

Understanding Retinopathy of Prematurity Care

Conditions We Treat and Treatment Options

ROP is classified by stage (1 through 5), zone (how far from the center of the retina the disease extends), and the presence or absence of plus disease (dilation and tortuosity of the retinal blood vessels).

Stages 1 and 2 ROP involve mild to moderate abnormal vessel growth. Many cases at these stages resolve on their own without treatment, but they require close monitoring.
Stage 3 ROP involves severely abnormal vessel growth and may meet the threshold for laser or anti-VEGF treatment, depending on zone and disease status.
Stage 4 ROP involves a partial retinal detachment. Surgery may be needed to prevent further detachment and preserve vision.
Stage 5 ROP involves a total retinal detachment. Surgical intervention at this stage is complex, and visual outcomes are often limited.

Knowing when to treat and when to observe is one of the most consequential decisions in neonatal ophthalmology. The warning signs of progression are not visible to parents, which is why serial dilated exams by a retina specialist are the standard of care.

What Should You Expect from Retinopathy of Prematurity Screening?

Screening exams are performed with the infant’s eyes dilated. The exam is brief but may cause temporary discomfort. A speculum holds the eyelids open while the physician examines the retina.

Exams are typically repeated every one to three weeks, depending on the severity and location of any retinal changes.
If treatment is indicated, laser photocoagulation or anti-VEGF injection can often be performed at bedside in the NICU or in our office under controlled conditions.
Parents are informed of findings after each exam and involved in every treatment decision.

Follow-up care continues after treatment, with imaging to confirm that the retina is stable and that abnormal vessels are regressing.

What Is the Typical Screening and Treatment Timeline?

Initial screening begins between 31 weeks postmenstrual age and four to six weeks after birth, depending on the infant’s gestational age and birth weight. Follow-up exams continue at intervals determined by the findings. A normal-appearing retina in zone III may be reassessed in two to three weeks. Active disease in zone I may require weekly exams.

Treatment, when needed, is typically performed within 48 to 72 hours of the decision to treat. Timely intervention is critical because ROP can progress rapidly. After treatment, exams continue until the retina has fully vascularized and the physician confirms that the disease has regressed.

Long-term follow-up extends beyond the neonatal period. Children who had ROP should continue to see a retina specialist or pediatric ophthalmologist annually to monitor for late complications, including high myopia and retinal detachment.

What Should You Bring to Your Baby’s First Visit?

Your baby’s insurance card and your photo ID
A referral or summary from the NICU team, neonatologist, or pediatrician
Discharge paperwork from the hospital, including gestational age, birth weight, and any oxygen therapy records
Records of prior ROP screening exams, including staging and treatment notes
A list of any current medications your baby is taking

If your baby has already been discharged from the NICU, bring any documentation the hospital provided about recommended follow-up timing.

What Are Some Important California Retinal Health Resources for Families?

Parents and caregivers in California can access reliable information on retinopathy of prematurity through the following public sources.

Medical Board of California allows you to search the license status and history of any physician licensed to practice in the state.
National Eye Institute provides a detailed overview of ROP stages, risk factors, screening recommendations, and treatment options supported by federal clinical research.
MedlinePlus offers a plain-language overview of retinopathy of prematurity, including causes, symptoms, staging, and treatment information reviewed by medical professionals.

These informational resources do not replace a clinical evaluation by a qualified retina physician.

Contact Retina Associates of Orange County

Retinopathy of prematurity does not end when your baby leaves the NICU. Many parents assume that once their child is home and healthy, the eye risk has passed. But ROP can progress after discharge, and even infants whose ROP has resolved face a higher lifetime risk of retinal detachment, high myopia, and other complications that require ongoing monitoring. If your baby was born prematurely, especially before 31 weeks or under three pounds, a retina evaluation is an essential part of their long-term care.

Our retina physicians see patients at offices in Laguna Hills, Newport Beach, Santa Ana, and Huntington Beach. We coordinate with NICUs and pediatricians throughout Southern California and accept most major insurance plans. Contact us to schedule a retinopathy of prematurity evaluation with a board-certified retina specialist in California.

Patient Reviews