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Provider photo for Eun-Ha Park

Eun-Ha Park, MD

Ophthalmology

Welcome to My Doctor Online, a website my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. If you are a patient who sees me regularly, you can reach my office directly at 415-833-5110.

My Offices

Daly City Medical Offices
Appt/Advice: 650-301-5800

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Overview

Macular pucker is caused by the contraction of scar tissue that has formed on the macula, a pin-sized area at the center of the retina. The retina is a thin layer of tissue that lines the back wall of your eye. It converts light into electrical signals and sends them to the brain, which interprets them as images. The macula ensures that we can focus clearly, particularly when looking straight ahead. A healthy macula is important for activities like driving and reading.

Scar tissue can develop as part of a medical condition, an injury, or the aging process. As we grow older, the jellylike vitreous that makes up most of the inner part of the eye shrinks and becomes more liquid. As it shrinks, it separates from the retina and creates a space where scar tissue can sometimes grow over the retina. This scar tissue is known as an epiretinal membrane.

The scar tissue may shrink over time or crinkle like cellophane. If it contracts sufficiently, it can wrinkle the surface of the retina or cause it to pucker. If the scar tissue is near, or on, the macula, this puckering can pull the macula out of its normal position and affect your central vision.

Symptoms

Some people have no symptoms at all. If you do develop symptoms, you may notice that the center of your visual field is less sharp and blurred. Flat or level objects may look wavy, crooked, or smaller than they really are. In severe cases, you may notice a blacked-out area in the center of your vision. These symptoms are similar to those experienced by people with age-related macular degeneration (AMD).

Additional References:

Causes

There are a number of factors that increase your risk of developing scar tissue and/or macular pucker. They include the following:

  • Age. Older people are more likely to develop macular pucker.
  • Diabetes. Diabetes can lead to macula problems. In addition, diabetic retinopathy increases your risk of developing scar tissue.
  • Trauma. Any prior eye injury can cause scarring that can affect the retina and macula.
  • History of retinal tears or holes. 
  • Inflammatory conditions in the eye. People with a history of inflammation in the eye can develop scar tissue.
Additional References:

Diagnosis

We can schedule a general eye exam for you in either our Optometry or Ophthalmology department. However, if you have sudden vision changes, especially if you have a family history of macular degeneration or have diabetes, contact us to schedule an urgent appointment with me or one of my colleagues in the Ophthalmology department.

We will ask you about your symptoms and examine your eyes. If we suspect macular pucker, the examination will include the following tests:

  • Ophthalmoscopy. We use a strong light and magnifying lens to examine your retina and macula for signs of scar tissue and damage. We may also photograph your eye during this exam. We usually administer eyedrops first to dilate your pupils so that we can see the structures at the back of your eye clearly.
  • Visual acuity test. Just like a regular eye exam, this tests the strength of your central vision by requiring you to read letters on a wall chart some distance away.
  • Optical coherence tomography (OCT). If we suspect that you have a macular hole, we may perform a computerized eye scan called optical coherence tomography.

Treatment

In many cases, we don't need to treat macular pucker. Often, the visual distortions are not serious and do not affect your ability to live a normal life. In a small number of cases, the problem fixes itself when the epiretinal membrane breaks away from the surface of the macula on its own, resolving the puckering. However, in some cases, the epiretinal membrane and/or macular pucker causes significant distortion of vision, and surgery may be necessary to help prevent your vision from getting worse. The surgical procedure, known as a vitrectomy, may even improve your vision.

Vitrectomy

We usually recommend this procedure if your vision is severely affected, preventing you from performing your usual activities. This procedure is performed by a vitreoretinal surgeon who specializes in operating in the posterior segment of the eye.

Before the procedure, we administer local or general anesthetic. During the procedure, the surgeon removes the vitreous gel that is tugging on the macula, using microsurgical instruments. Once the vitreous has been suctioned out, the surgeon carefully removes the epiretinal membrane from the retinal surface, using microscopic surgery. At the end of the surgery, the vitreous gel is replaced with saline, intraocular gas, or silicone oil to restore normal pressure in the eye and allow optimal healing of the retina. 

Most people experience some improvement in their central vision after the surgery. However, the procedure may not restore all the vision that has been lost. It may take a number of months for vision to improve.

Complications

Unfortunately, a vitrectomy does increase your risk of developing cataracts. If you already have a cataract, we may perform cataract surgery at the same time as the vitrectomy. This also helps the surgeon to see the macular pucker and/or epiretinal membrane more clearly. We will discuss the benefits and risks with you before scheduling your surgery.

Your Care with Me

If your optometrist identifies a problem with your macular during your eye exam, he or she will make an appointment for you to see me or one of my colleagues in the Ophthalmology department. If you are not scheduled for a regular eye exam and you notice symptoms such as dim or blurry central vision or a blind spot, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week.  Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you.

Your first appointment is likely to take at least 1 hour and possibly longer. During your office visit, we will discuss your medical and family history and I will perform a comprehensive eye exam and some diagnostic tests.

I may administer eyedrops to dilate your pupils so that I can clearly see the structures of your eyes. Your pupils will remain dilated for several hours, so you may wish to bring someone who can drive you home after your exam.

I will explain the findings of your exam and answer any questions or concerns you may have. If you notice any new changes, please let me know.

If we decide that you need further evaluation, or further treatment or surgery, I will discuss the treatment options that are available, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:
  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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