Epiretinal membrane (ERM), also known as macular pucker or cellophane maculopathy, is a thin layer of scar tissue which grows over the macula (the central part of the retina). The retina is sometimes referred to as the eye’s camera. It sits at the back of the eye where it senses light and sends signals to the brain so that you can see. The macula is the part of the retina responsible for your central vision and helping you to see fine details clearly. As an epiretinal membrane develops over your macula, it may not appear to affect your vision at all. However, with time it can contract (shrink) and lead to distorted or blurred vision.
Epiretinal membrane (ERM)
Also known as: Macular pucker, Cellophane maculopathy
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What causes epiretinal membrane (ERM)?
There are various causes of an epiretinal membrane:
- age – as you get older, the vitreous (jelly inside the eye) may pull away from the retina. This is called posterior vitreous detachment (PVD) and is very common, particularly in people over the age of 50 years. Posterior vitreous detachment may be followed by the development of epiretinal membranes in a minority of people.
- retinal laser treatment – retinal laser can be associated with epiretinal membrane. However, it may be that the underlying condition that requires laser treatment is also responsible for the epiretinal membrane, such as retinal tears, retinal detachment, and diabetes.
- diabetic retinopathy – having too much sugar in your blood can cause changes in the blood vessels that go to your retina, ultimately damaging it.
Epiretinal membrane symptoms
Many patients with an epiretinal membrane may not develop any symptoms at all. However, epiretinal membranes can progress slowly and cause:
- a distortion or loss of clear central vision
- straight lines to appear wavy or crooked
- blurred vision
- difficulty reading and writing
- the sensation of a ‘film’ or ‘smudge’ in your vision
- objects appearing to be smaller or larger than they are
Importantly, epiretinal membranes should not cause any pain.
Epiretinal membrane treatments
Your treatment plan will depend on how advanced your epiretinal membrane is. For example, if it is identified during a routine eye exam and is not causing any symptoms, treatment may include conservative observation approaches.
However, if your epiretinal membrane (ERM) is progressing and affecting your vision, the only way to treat it is to remove the membrane through a surgical procedure called a vitrectomy.
Vitrectomy
A vitrectomy takes approximately one hour and is performed under either a local or general anaesthetic.
Your surgeon will discuss the procedure with you in further detail. Vitrectomy involves making three very small keyhole openings in the eye and removing the vitreous gel. After removing the gel the surgeon peels off the epiretinal membrane of the retina. The gel is replaced with a watery solution.
Our surgeon will explain the risks and benefits of surgery, but generally, vitrectomy is a safe and commonly performed day-case procedure, meaning you should be able to go home on the same day. However, you should make sure to ask a friend or family member to drive you home from the clinic after your procedure.
When to see a consultant?
Due to a lack of symptoms, in many people, epiretinal membranes are only spotted and diagnosed during a routine eye examination. As a result, it’s important to have regular eye exams to keep on top of your eye health.
However, if you experience any of the symptoms above, you should book an appointment with an eye specialist as soon as possible.
Epiretinal membrane diagnosis
To accurately diagnose an epiretinal membrane, and determine its severity, we will usually recommend an optical coherence tomography (OCT) scan. OCT is a very high-resolution laser scan of your retina that shows the epiretinal membrane in fine detail.
To look for an underlying cause of your epiretinal membrane, you may also require an Optos photograph of your peripheral retina, and much less commonly, a fluorescein angiogram.
Our multidisciplinary approach and advanced diagnostic tools then allow us to develop an optimal treatment plan for you.
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