Retinal Degeneration
An Epiretinal Membrane (also known as ERM) is a fibrous tissue overgrowth that occurs on the internal surface of the retina, overlying the central macula. Very often, it leads to traction and wrinkling of the retina which leads to decreased vision and metamorphopsia.
Epiretinal Membranes are also known alternatively as macular puckers, or cellophane maculopathy (due to the resemblance to cellophane tape). They manifest as translucent membranes that attach to the inner surface of the retina inside the eye. The affected eye usually experiences minimal symptoms and usually does not require immediate action. Though sometimes, the epiretinal membrane can result in loss of vision without pain, or cause distortion in vision.
In a general sense, epiretinal membranes project symptoms most frequently when it grows over the macula – the part of the retina that we use to distinguish finer details, such as reading.
The cause of an epiretinal membrane forming is due to a fault in the interior coating of the retina where a group of cells – glial cells, can relocate and start to grow in a membranous layer on the retinal surface. This membrane can resemble cellophane. It also runs a risk of shrinking as time passes. If this film shrinks, it may pull on the parts of the retina that it is attached to and result in a macular pucker, or lead to a wrinkle on retina surfaces, causing damage. As a result of damage caused, symptoms like distorted or even loss of vision, particularly central vision.
Epiretinal Membranes can be linked with a range of eye conditions such as retinal tears, retinal detachment or macular pucker. Also related are vascular diseases of the retina, like diabetic retinopathy or vascular occlusions. There has been data to show that epiretinal membranes can also occur after certain events that may cause trauma, such as ocular surgery, or be associated with intraocular (inside the eye) inflammation.
The leading risk for an epiretinal membrane to form correlates with increasing age. Although conditions such as myopia, inflammatory conditions or prior eye laser surgeries or traditional surgeries may increase the risk of a person developing an epiretinal membrane at an earlier age.
Since it is a degenerative change, an Epiretinal Membrane may be thought of as an unwanted ‘scar tissue’ that occurs on the retina.
Most sufferers of epiretinal membranes exhibit no symptoms. The existence of their ERMs are only discovered during a dilated retinal exam with their eye specialist, or when retinal imaging is done, such as during ocular coherence tomography (OCT). Patients in this situation typically do not describe noticeable changes in their vision, and possess normal or near-normal vision. However, epiretinal membranes can slowly progress in the eye, leading to visual distortions. A simple way to more clearly discern these distortions is to close the eye that is NOT experiencing or less affected by epiretinal membrane.
These are some symptoms that can indicate you require epiretinal membrane treatment:
When these symptoms become more pronounced or progressively worsen, epiretinal membrane surgery may be recommended to relieve the traction on the retina.
Left untreated, this condition can slowly degenerate and eventually lead to decreased vision. In rare cases, ERMs may also result in double vision, light sensitivity or magnification of images, making the objected view seem larger or smaller than they actually are.
Most ERMs are observed to stay somewhat constant after the first stage of growth. In these cases, the ERM can simply be kept under observation as long as it does not present a significant obstruction to the patient’s visual ability. There have been select cases, however, where the ERM will automatically detach itself from the retina, releasing the traction and also resulting in an alleviation in visual symptoms. However, if an eye exam shows marked progression of size and growth of the ERM, and/or a degeneration in the visual ability or acuity of the patient, epiretinal membrane surgery may be recommended.
The standard surgical approach is a vitrectomy with membrane peeling. This is a minimally invasive, microsurgical procedure performed through very small incisions in the eye. During the surgery:
The epiretinal membrane surgery in detail is executed via microscopic ‘keyhole’ surgery. Three tiny self-sealing incisions (each less than 0.5mm in size) are all that are needed to remove ERM. Visual outcomes are best when the membrane is removed early before it causes any damage to the retina.
Visual recovery after surgery can vary. Many patients experience an improvement in distortion and clarity over time, although the extent of recovery often depends on how long the membrane has been present and whether any permanent retinal changes have occurred.
In general, timely intervention when symptoms begin to affect vision can improve outcomes while avoiding unnecessary surgery in mild or stable cases.
In most cases, an epiretinal membrane is not sight-threatening, especially in the early stages. However, it is still important to have it properly assessed and monitored, as it can affect vision over time in some patients.
In most cases, vision changes from an epiretinal membrane develop gradually rather than suddenly. Regular follow-up helps ensure any changes in vision are detected and managed early.
Yes. Periodic follow-up is usually recommended, even if the condition is stable. This allows your doctor to monitor for any changes in vision and ensure that management remains appropriate over time.
There are no specific lifestyle changes proven to prevent progression of an epiretinal membrane. In most cases, the condition is managed through regular review, so any changes in vision can be identified early and treated if necessary.
