Epiretinal Membrane
What is an epiretinal membrane (ERM)?
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An epiretinal membrane, also called macular pucker, is a thin layer of scar tissue that forms on the surface of the retina, the light-sensitive tissue at the back of your eye (like what a film is to a camera).
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Think of your retina as a flat thin bedsheet that is spread out evenly - nice and flat. Any wrinkling of this surface can result in decreased and distorted vision. An epiretinal membrane is like a creeper plant that slowly grows across the retina, wrinkling it up and subsequently causing visual disturbance.
The retina is meant to be spread out evenly like a nice and flat bedsheet, with no "creases"
An epiretinal membrane causes "wrinkling" of the retina, making it look like this bedsheet
What causes epiretinal membranes (ERM)?
Epiretinal membranes are most common in people over 50. There are many causes for ERM development, however they commonly develop as a result of aging changes that occur in the vitreous gel within the eye.
What are the symptoms of epiretinal membranes?
Many people with early or mild epiretinal membranes have minimal to no symptoms. However, as this progresses, patients experience:
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Blurred vision
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Wavy or distorted vision (metamorphopsia) - straight lines appearing wavy
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Difficulty reading or seeing fine details
How are epiretinal membranes diagnosed?
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A macular hole is usually diagnosed initially by an optometrist or ophthalmologist using a special imaging tool called optical coherence tomography (OCT), which takes detailed scans of the eye.
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Once they suspect or diagnose an epiretinal membrane, the patient is then referred to me for further care.
Do I need treatment for an epiretinal membrane?
It depends on the severity of the epiretinal membrane. Severe epiretinal membranes cause visual disturbance and require surgical intervention. Mild epiretinal membranes that do not cause any visual disturbance can be monitored over a few visits. If there is progression of disease, I usually recommend surgery to prevent it from causing irreversible changes to your retina.
How successful is surgery for an epiretinal membrane?
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The removing of an epiretinal membrane is a delicate but usually very safe procedure, especially after having spent years refining my surgical technique. This is almost always achieved, and the retina typically looks better within a week or 2 on our eye scans. I would call this anatomical success.
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Visual recovery on the other hand, is a slow and steady process and can take many months. Think of a VERY wrinkled bedsheet that has very stubborn creases no matter how much you try to iron it out – it will take a long time to for this to smoothen out! Also in more severe cases, vision usually improves but does not go back to being perfect or how it was when you were a spritely young teen. Patients may still notice some distortion, however this should be less noticeable, and more importantly – the removal of the membrane stops further progression and loss of vision!
What can I expect if I have surgery?
Surgery is usually done under local anaesthetic with some mild sedation i.e. anaesthesia is used to numb the eye whilst some relaxing medication is given via a drip.
All you have to do is lie still on your back, listen to the relaxing music being played whilst the surgery is performed. This takes approximately 45 minutes.
After surgery, a pad is used to cover your eye, and you are then discharged home. I usually see my patients the next day to ensure everything is going according to plan.
How long does recovery take?
I usually advise patients to take at least 1-2 weeks off work and will provide a medical certificate for this. At the end of the surgery, I may leave a small air bubble in your eye that disappears in about 1-2 weeks, during which you cannot fly or travel to places with a significant change in atmospheric pressure (mountains or diving).
During these 2 weeks, take it easy, avoid any straining or heavy lifting, keep the eye clean, read a book, spend time with the family, watch some Netflix and go out for nice leisurely walks.
Are there any risks of surgery?
Yes, as with any surgical procedure (or even daily activities such as driving), there is always a chance that complications can happen. Fortunately however, the risks of serious complications such as an infection inside the eyeball (endophthalmitis) are very low - the risk of this is approximately 1 in 3000 (0.03%). The other way of viewing it is that if surgery is not performed, there is a 100% chance of no improvement and very likely worsening of vision over time.
Click here for a more detailed explanation of the risks of surgery.