Understanding epiretinal membrane: causes, symptoms, and treatment
Dive deep into the world of eye health with our comprehensive guide to the epiretinal membrane. Learn about the causes, symptoms, diagnosis, and treatment options for this common age-related eye condition. Acquire the knowledge to effectively maintain and manage your vision.
The epiretinal membrane, also called macular fold or cellophane maculopathy, is a thin, transparent layer of fibrous tissue that forms on the inner surface of the retina, specifically the macula, the part of the eye responsible for sharp central vision. This condition can cause distortion and blurring in the central vision. It is often associated with aging, but can also be caused by other eye diseases such as retinal detachment, eye inflammation, and trauma. Not everyone with an epiretinal membrane is symptomatic, and treatment, often involving surgery, is usually recommended only if vision is severely impaired.1
However, there is still much to be understood about the epiretinal membrane. How is it created? How does it affect our daily lives? And most of all, what can we do to address and treat it? Dig deep and read on.
The epiretinal membrane, also called macular pucker or cellophane maculopathy, is a thin layer of fibrous tissue that forms over the macula (the central area of the retina responsible for sharp, straight vision). These membranes can produce a variety of visual effects, ranging from minor, slightly perceptible impairments to severe visual impairments. However, not everyone with an epiretinal membrane experiences symptoms. This condition is especially common in older people.1
Causes of epiretinal membrane
The main cause of the epiretinal membrane is age-related changes in the vitreous humor (the clear, gel-like substance that fills the center of the eye). As we age, the vitreous shrinks slowly and can sometimes detach from the retina, causing microscopic damage to the surface. This stimulates the growth of the fibrous tissue that forms the epiretinal membrane.2
In addition to the natural aging process, several other factors may contribute to epiretinal membrane development. These include eye inflammation, retinal tears or detachments, severe eye damage, and eye conditions such as diabetic retinopathy and retinal vascular disease. Rarely, an epiretinal membrane can develop after eye surgery.1
Signs and symptoms of epiretinal membrane
Symptoms of the epiretinal membrane vary greatly from person to person and are highly dependent on the thickness and location of the membrane. Some people are unaware of their condition, while others experience significant visual impairment. Common symptoms include worsening vision, blurred vision (metamorphopsia), wavy or curved straight lines, difficulty reading, and seeing a gray or cloudy area in the center of vision.
When symptoms associated with an epiretinal membrane start to emerge, the membrane becomes more evident on the retina's surface, leading to a condition often referred to as "macular pucker". Notable crinkles or streaks can be seen on the retina, and the retinal blood vessels appear twisted in areas where the membrane is shrinking, but seem elongated or expanded in surrounding regions.
Management and treatment for epiretinal membrane
Treatment of the epiretinal membrane depends largely on the severity of the symptoms. In mild cases where vision is minimally affected, no treatment is required and normal activities can be continued and vision changes monitored.
Surgical intervention may be recommended if the membrane significantly impairs vision. An operation called vitrectomy is usually performed, often in combination with membrane detachment. In this surgery, a surgeon removes the vitreous from the eye and detaches the epiretinal membrane from the retina. Then they replace the vitreous with saline.2
Are you considering surgery?
According to RNIB, the decision to undergo epiretinal membrane surgery is a personal choice and depends on individual circumstances and perceived visual impairment. Without surgery, some people learn to tolerate changes in vision in one eye, especially if the other eye continues to see well. The brain is highly adaptable and can adapt over time to the visual impairment of the affected eye, minimizing discomfort.
Untreated, her ERM poses no further risks or complications to eye health.
Effectiveness of surgery
The main advantage of opting for surgery is the possibility of improving vision or even completely correcting visual impairment. The majority of patients notice significant improvement within one month after surgery.
Approximately 80% of people who undergo surgical removal of the epiretinal membrane experience improvement in visual acuity (measured by ability to read a visual acuity chart).
Full recovery after surgery, which is characterized by the most noticeable improvement in vision, takes about 2-3 months. However, further gradual improvement may last up to 6 to 12 months before final vision levels are reached after treatment.
The degree of visual recovery after surgery depends on factors such as the quality of preoperative vision, duration of visual impairment, possible surgical complications, and whether the condition is idiopathic (due to an unknown cause) or secondary to another disorder. It depends on several factors.
Your eye specialist will be able to provide an estimation of potential vision improvement post-surgery, assisting you in making an informed decision about whether to proceed with the surgery.
While the surgery has high success rates, potential risks include infection, retinal detachment, and cataract development. Therefore, the decision for surgery should be made in consultation with an experienced ophthalmologist.2
Diagnosis of epiretinal membrane
Diagnosis of the epiretinal membrane begins with a comprehensive ophthalmologic examination. This usually involves dilating the pupil and examining the retina with an ophthalmoscope. Your eye doctor may also perform retinal photography and fluorescein angiography. This involves injecting dye into a vein in the arm and taking pictures of the eye to observe the flow of dye through the blood vessels of the retina.
The main diagnostic tool for the epiretinal membrane is optical coherence tomography (OCT). This non-invasive imaging test uses light waves to obtain detailed images of the retina, allowing doctors to clearly visualize the epiretinal membrane and measure its thickness.3
The main risk factor for the development of epiretinal membranes is age. The condition is rare in people under 50, but its prevalence increases with each decade of life. Other risk factors include a history of retinal tear or detachment, previous eye surgery, uveitis (inflammation of the middle layers of the eye), and vascular diseases affecting the retina such as diabetic retinopathy.
Left untreated, severe epiretinal membrane can lead to significant vision loss.
Complications may occur with surgical treatment. For example, there is a small risk of membrane recurrence after surgery. Other potential risks associated with surgery include retinal detachment, infection, bleeding, and the development of cataracts.
How can I prevent epiretinal membrane
Unfortunately, there are no specific precautions against epiretinal membranes, as they are often associated with natural aging processes and other unavoidable diseases. However, regular eye exams lead to early detection and treatment, reducing the risk of severe vision loss.
How common is epiretinal membrane
Epiretinal membranes are found in approximately 7% of the population and their incidence increases with age.1
When should I see a doctor
You should see a doctor if you notice changes in your vision, such as Blurring, distortion, or other visual impairment. Regular eye exams are also recommended, especially for those over the age of 50, or those with a history of eye disease.1
Epiretinal membrane is a relatively common eye disease, especially in people over the age of 50. These can cause a variety of symptoms, and when vision is severely impaired, surgery is the main treatment required. Regular eye exams ensure early detection and effective treatment and help maintain eye health and vision quality.
- Johnson MW. (2010). Etiology and treatment of macular edema. American Journal of Ophthalmology, 149(2): 291-297. Available at https://pubmed.ncbi.nlm.nih.gov/18789796/
- Steel DHW, Lotery AJ. (2013). Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye, 27(Suppl 1): S1-S21. Available at: https://pubmed.ncbi.nlm.nih.gov/24108069/
- Yeh S, Khurana RN, Shah M, et al. (2020). Clinical utility of OCT in the diagnosis and management of macular disorders. Ophthalmic Surgery, Lasers and Imaging Retina, 51(4): 200-212. doi:10.3928/23258160-20200401-02