Epiretinal membrane (ERM), often called macular pucker, can subtly affect your vision. Our compassionate retina specialists are dedicated to helping you understand and manage this condition effectively, ensuring you receive tailored care that addresses your unique needs.
This page provides a comprehensive overview of epiretinal membranes (ERM), including their definition, causes, symptoms, diagnostic methods, treatment options, recovery expectations, and the importance of early detection. Our Retina Specialists are here to guide you through every aspect of managing this condition.
An epiretinal membrane, sometimes called macular pucker or cellophane maculopathy, appears as a semitranslucent sheet of tissue on the retina’s inner surface. This membrane tends to develop when cells, most notably glial cells, migrate from deeper layers of the retina and proliferate, forming a fragile film. Over time, this tissue may contract, tugging subtly on the macula, which leads to changes in vision.
Most individuals with ERM have minimal symptoms at first, and the condition is often discovered during routine eye exams. However, if the membrane starts to affect the macula significantly, you might notice changes in your central vision such as distortion, blurriness, or challenges with fine details. Here’s the thing: understanding exactly what this membrane is and how it affects your sight can empower you to make informed decisions regarding your eye health.
The most common cause of an epiretinal membrane is directly linked to the natural aging process of the eye. Your eye is filled with a gel-like substance called the vitreous. As you age, this vitreous gel naturally shrinks and pulls away from the retina's surface. This event is called a posterior vitreous detachment (PVD) and is a normal part of aging. Sometimes, as the vitreous separates, it can stimulate a healing response on the retina, causing cells to form a sheet of scar tissue.
Certain pre-existing eye conditions can increase the likelihood of developing an ERM. This is often referred to as a secondary epiretinal membrane. Conditions that cause inflammation or disruption to the retina, such as retinal tears, retinal detachment, or retinal vascular diseases like diabetic retinopathy and retinal vein occlusion, can trigger the cell growth that leads to membrane formation. Chronic inflammation within the eye, known as uveitis, is another significant contributing factor that can lead to this condition.
Any event that disturbs the delicate structures of the eye can potentially lead to the formation of scar tissue on the retina. A history of significant eye trauma or injury can be a precursor to developing an ERM. Furthermore, previous intraocular surgery, while beneficial and necessary, can also slightly increase the risk. Procedures such as cataract surgery or retinal surgery, although performed with extreme precision, can sometimes initiate an inflammatory or healing response that results in a macular pucker.
In a majority of cases, an epiretinal membrane develops simply as a result of a posterior vitreous detachment (PVD) without any other associated eye disease, injury, or surgery. When there is no other specific cause identified, our retina specialist will refer to the condition as an "idiopathic" epiretinal membrane. This is the most common presentation, highlighting that for many patients, an ERM is an isolated event related to the natural aging of the eye.
Many patients with an epiretinal membrane might not notice any symptoms right away. However, as the membrane thickens or contracts, several visual changes can occur. Here’s what to be aware of:
The most common symptom is a gradual loss of clarity in your central vision, making it harder to read fine print or see facial details clearly.
Straight lines may appear wavy, bent, or crooked. For instance, door frames or the edges of windows might not look as they normally do.
Your ability to distinguish fine details may decrease, affecting tasks such as reading or recognizing faces.
Colors and contrasts can seem muted or less defined, making it challenging to navigate in low-light environments.
Diplopia related to ERM is most often binocular and results from retinal misregistration (central-peripheral rivalry); true monocular diplopia from ERM alone is uncommon.
Understanding the risk factors associated with epiretinal membranes can help you take proactive steps toward maintaining your eye health through regular check-ups and proper management of any underlying conditions. Here are some key risk factors:
The likelihood of developing an ERM increases with age. Studies have shown that Population-based studies show ERM prevalence rises from roughly 3–5% in adults aged 50–59 to 10–20% in those older than 70, with rates peaking around 11–15% in the 70–79 age group.
Histories of retinal tears, detachment, or conditions like diabetic retinopathy and retinal vein occlusion can elevate the risk of ERM. Even previous eye surgeries, such as cataract surgery, can slightly increase the chance of ERM formation.
Conditions like uveitis, where intraocular inflammation occurs, are linked to an increased probability of ERM development due to the inflammatory process triggering cell migration and scar tissue formation.
Injuries to the eye that lead to retinal damage can result in ERM as part of the natural healing, or sometimes scarring, process.
Diagnosing an epiretinal membrane is highly accurate thanks to advanced imaging and careful examination.
A dilated retinal exam lets our retina specialists inspect the back of your eye for any abnormal tissue growth or changes related to an epiretinal membrane.
Optical Coherence Tomography (OCT) is a non-invasive scan that provides detailed, cross-sectional images of the retina. This test helps measure the thickness of the membrane and assess its effect on the macula.
Ultrawidefield fundus imaging captures panoramic views of the retina. This broader look helps identify any related retinal conditions that could influence treatment.
When further evaluation of the retinal blood vessels is needed, fluorescein angiography may be used. This test involves a safe dye and highlights blood flow or leakage, giving additional insight into your retinal health.
For individuals with mild ERM who experience little to no visual impairment, monitoring the condition through regular eye examinations is typically the best course of action. During these visits, high-resolution OCT scans are used to track any changes in the thickness of the membrane or its effect on the macula. If the ERM remains stable and does not significantly interfere with your vision, follow-up exams will help us ensure that no further action is needed at that time.
Don't let vision changes hold you back! Schedule a consultation with experienced retina specialists in your area who can provide personalized advice and treatment options for epiretinal membranes. Your sight is important, and our professionals are here to help you every step of the way.
In cases where the epiretinal membrane leads to noticeable visual distortion or blurred central vision, surgical intervention might be necessary. The procedure commonly performed by our team is called a vitrectomy with membrane peel. Here’s what the surgery generally involves:
After undergoing vitrectomy and membrane peel surgery, your recovery journey is carefully managed by our dedicated team. Recovery is usually gradual, and it’s essential to adhere to the aftercare plan provided by our specialists for the best outcomes.
During the post-surgery period, you can expect:
Initial visual gains usually appear within the first few months, but best-corrected visual acuity can continue to improve for up to 2–3 years after epiretinal membrane peeling before stabilising.
We schedule periodic appointments post-surgery to monitor your healing process using high-resolution OCT and other imaging methods. These visits help us detect any complications early and address them promptly.
You will be provided with specific instructions regarding eye drops to prevent infection and reduce inflammation, as well as guidelines on activity restrictions to ensure the surgical site heals properly.
When we discuss the outlook for an epiretinal membrane, it’s important to recognize that many ERMs remain stable over time without progressing to severe vision loss. In cases where an ERM does affect vision, the outcome can often be improved with careful monitoring or, in more pronounced cases, surgical intervention.
The prognosis typically depends on factors such as:
Ongoing care after treating an epiretinal membrane is essential for the best possible outcome.
Consistent appointments with your retina specialist help monitor the healing process and catch any issues early. Early detection of changes allows for prompt management and supports a smooth recovery.
After surgery, follow-up imaging, especially with OCT, lets your specialist track how well the macula is healing. These tests confirm that the membrane is no longer causing traction and that your retina is returning to its normal shape.
You may be given prescription eye drops to reduce inflammation and prevent infection after surgery. Our team will provide clear instructions to help you use these medications effectively and support your recovery.
During the healing phase, you may need to avoid heavy lifting or strenuous activity. Limiting these actions helps protect your eye and encourages a safe, successful recovery.
Spontaneous ERM separation is uncommon, reported in approximately 1–3% of cases, most often in younger patients or membranes secondary to inflammation. The vast majority of ERMs, once formed, will either remain stable or slowly progress over time. For this reason, relying on the membrane to heal itself is not a viable strategy. If symptoms are not present, our retina specialist will recommend monitoring, and if symptoms are significant, surgery is the only reliable treatment option available.
Because most epiretinal membranes are caused by the natural aging process within the eye, there is no guaranteed way to prevent one from forming. However, you can take steps to protect your overall retinal health. This includes getting regular, comprehensive eye exams, especially after age 50. If you have underlying health conditions like diabetes, managing them effectively can reduce your risk of secondary ERMs. Additionally, always protecting your eyes from injury by wearing safety glasses during hazardous activities is a crucial preventative measure.
The decision to have surgery is based on how much the ERM is impacting your personal quality of life. Our retina specialist will make a recommendation based on your clinical findings, such as your visual acuity and the degree of distortion shown on your OCT scan. However, the final decision is yours. If you find that your vision is preventing you from reading comfortably, driving safely, or enjoying your hobbies, it is likely time to seriously consider the surgical option.
Having an epiretinal membrane in one eye does place you at a slightly higher risk for developing one in your other eye. Studies show this occurs in about 10-20% of patients. However, it is not a certainty. Many people will only ever have an ERM in one eye. If you do develop one in the second eye, it may not progress in the same way or to the same degree of severity. Regular monitoring of both eyes is the best way to track your health.
Don't let vision changes hold you back! Schedule a consultation with experienced retina specialists in your area who can provide personalized advice and treatment options for epiretinal membranes. Your sight is important, and our professionals are here to help you every step of the way.
Explore epiretinal membrane (ERM) symptoms, diagnosis, and treatment options with expert retina specialists listed at Specialty Vision.
