Epiretinal Membrane: Causes, Symptoms, Diagnosis and Treatment

Epiretinal Membrane: Causes, Symptoms, Diagnosis and Treatment
InSinc

Epiretinal membrane (ERM) is an eye condition that may sound strange to a lot of people. Although unpopular, epiretinal membrane is common and affects some of us unknowingly. 

A study conducted among Singapore residents, composed of Chinese, Malay and Indian ethnicities, showed that epiretinal membrane is affects a number of Asians and is often observed among Chinese. The study further found that certain factors increased the risk in some people. This includes ageing, diabetic retinopathy, and cataract surgery.

It is not surprising, however, that little is known by Singaporeans about this eye condition. To spread awareness, Dr Claudine Pang shares her proficient knowledge about this topic.

Epiretinal membrane definition

Human eye anatomy

Epiretinal Membrane, otherwise known as macular puckers or cellophane maculopathy, is a condition that affects the eye’s macula, which is located at the centre area of the retina. The macula plays a vital role in processing details by allowing the eyes to see images and objects in standout colour and “20/20” vision.

Epiretinal membrane occurs when an extremely thin layer of scar tissue develops on the retina’s exterior. This then affects the macula may end up swelling, wrinkling, and shrinking, which results in a blurred or deformed central vision. Epiretinal membrane can affect one or both eyes.

Causes of epiretinal membrane

Epiretinal membrane can happen to anyone, although there are certain people who may have an increased risk of developing them. The factors that may cause epiretinal membranes include:

  • Ageing – common in people over 60 years of age
  • Individuals with high myopia
  • Individuals who have undergone laser eye therapy
  • Individuals who have undergone eye surgeries
  • Individuals with pre-existing eye conditions or diseases, such as diabetic retinopathy, interior eye inflammation, myopic degeneration, or torn retinas

Symptoms of epiretinal membrane

Epiretinal membrane can be asymptomatic, meaning there can be no sign at all that they are present in your eye. By the time the signs appear, the epiretinal membrane is already progressing, albeit slowly.

Symptoms of epiretinal membrane include:

  • Blurring of vision
  • Gradual loss of central vision
  • Vision distortion (straight lines appear wavy)

Diagnosing epiretinal membrane

Of course, consulting a retinal specialist is the best way to see whether you have developed this condition or not. Your doctor will submit you to a detailed eye check-up to see if your retina or vitreous is affected by any condition or disease. Expect to undergo an Optical Coherence Tomography (OCT) scan and, if necessary, a test called Fluorescein Angiography (FA).

  • Optical Coherence Tomography (OCT) – This is a non-invasive procedure that uses light to form a 3D image of the eye for the doctor to evaluate.

Optical coherence tomography

  • Fluorescein Angiography (FA) – This method uses sodium fluorescein, which is a yellow dye that is administered to a vein in the arm with the use of an injection. Once injected, the dye then travels to the eye where a special camera is used to view its circulation in the retina and choroid located in the  back of the eye.

Depending on the severity of your epiretinal membrane, your doctor may recommend surgery in order to remove it. Close monitoring should be done for conditions that have minor or no impact at all on a patient’s vision. In case the condition worsens over time, then treatment can be administered as advised by your doctor.

Treatment of epiretinal membrane

For now, there is only one way to treat epiretinal membrane effectively and that is through vitrectomy and membrane peeling, which is a surgical procedure. Pain will be less of your concern as the surgery is performed with the patient submitted to full sedation. Despite being surgical in nature, patients who undergo vitrectomy do not need to be confined in a hospital. The success rate of this treatment varies per patient and ranges from 85% to 95%.

Patients with epiretinal membrane present for a long time may not benefit from vitrectomy if it is found that the eye’s functionality will not improve after surgery.

Risks of epiretinal membrane surgery

While the vision improvement success rate following an epiretinal membrane surgery is high, there are also risks involved, such as recurrence of the condition, bleeding, development of retinal detachment, and acquiring infection. The complications brought about by these risks following a vitrectomy surgery are generally small and happens very rarely.

For people with cataracts, it is important to have your cataracts treated first as undergoing surgery to remove epiretinal membrane may hasten the progress of your cataract. 

Prevention of epiretinal membrane

“Is there a way to prevent epiretinal membrane?” is a question normally asked by patients. Unfortunately, science has found no proven method that can prevent the formation of epiretinal membrane.

Conclusion

Epiretinal membrane, among other eye condition, is very treatable and has a high success rate of vision improvement following vitrectomy surgery. People with this condition whose daily lives are not impacted negatively in a major way normally do not need to undergo surgery, although their condition must be monitored closely. Treatment intervention can be done once the symptoms have progressed and become severe.

 

Dr Claudine Pang
#15-10 The Paragon, 290 Orchard Rd,
Singapore 238859
+65 6732 1741