Epiretinal membrane - Causes and treatment

What is an epiretinal membrane?

To understand what an epiretinal membrane is, you first need to understand the retina and how it works. The retina is a delicate layer of cells at the back of the eye that captures external light, sending it to the brain, enabling sight. An epiretinal membrane (ERM) is a fine sheet of scar tissue that has formed on the surface of the retina. It is similar to a cloudy sheet of cellophane or clingfilm, that can crinkle and distort the retina. When an ERM forms on the sensitive central retina, called the macula, eyesight can be affected with blurring and distortion of vision.

What are the symptoms of an epiretinal membrane?

The effect on central vision can vary widely, from none to severe blurring and/or distortion, to the extent where only large-sized prints can be seen.

You may only notice the blurring or distortion when the other (dominant) eye is covered.

What are the causes of epiretinal membrane?

The main cause of epiretinal membrane is a natural change to the vitreous gel over time, leading to liquefication and/or separation from the retina (posterior vitreous detachment), stimulating epiretinal membrane formation.

It is however important to exclude other underlying causes such as retinal tear, retinal detachment, retinal vein occlusion and uveitis (inflammation of the eye), all of which can lead to more extensive and severe loss of central and peripheral vision unrelated to the epiretinal membrane.

Assessment and tests

It is important for an epiretinal membrane to be assessed by a retinal surgeon, to determine both the cause and extent of involvement.

This will involve:

Examination of both your eyes, including eye drops to dilate your pupils
Imaging of the retina. Optical Coherence Tomography (OCT) imaging is essential for detailed assessment of the severity of disease. Other tests that may be required include retinal colour imaging and fundus fluorescein angiography.

Figure 1a. Cross-section (green line) through a normal macula.

Figure 1b. Cross-section (green line) through a macula with a dense epiretinal membrane.

What is the best treatment for epiretinal membrane?

There are two treatment options for the management of epiretinal membrane – monitoring and vitrectomy surgery:

1. Monitoring of ERM

This is appropriate if the ERM has caused no or very little change to your vision. ERMs can remain stable.

2. Vitrectomy surgery

If there is a significant reduction in vision, and/or signs of worsening over time, surgical treatment in the form of vitrectomy and membrane peeling may be recommended by your retinal surgeon. The amount of improvement is relative to the severity of vision at the time of surgery. In other words, you are likely to do better with earlier treatment if the ERM is affecting you. Thus, consult your retinal surgeon before your vision is too severely affected, as this may give you a better surgical result.

What happens during vitrectomy for epiretinal membrane?

Vitrectomy involves sutureless micro-incisions through the white of your eye to enable removal of the vitreous gel. The vitreous can be safely removed, as its main function is to facilitate growth of your eye prior to birth. During vitrectomy, the ERM is gently peeled off the surface of the retina using extremely fine micro-forceps. An air or gas bubble is sometimes used at the end of surgery. Cataract surgery may be done at the same time. Overall, surgery takes between 30-60 minutes.

What to expect after vitrectomy for epiretinal membrane?

Your vision will be blurry for 1-2 weeks after the vitrectomy. The majority of improvement in vision is achieved within 1-2 months of surgery. Further smaller improvement can occur, in some cases up to 3 years following surgery. There will be some redness for 2-3 weeks.

Read our vitrectomy page for further details about what happens during and after surgery.

What is the success rate of surgery?

The success rate partly depends on the extent of retinal damage caused by the epiretinal membrane, assessed by specialist imaging of the retina, specifically OCT (optical coherence tomography). An experienced retinal surgeon will be able to identify factors that can affect your success rate.

Overall, the success rate is very good. There is over an 80% chance of improvement in vision, mostly seen in the first 1-2 months following surgery.

Other common FAQs

Is vitrectomy for epiretinal membrane safe?

The risk of worse vision is low. These include retinal tear, retinal detachment (1% or less), severe infection and bleeding to cause blindness (1 in 1000 chance), and high eye pressure. A significant proportion of patients will develop cataract following vitrectomy, particularly, in patients aged 50 or over. Your retinal surgeon may recommend combining cataract surgery with vitrectomy to reduce the need for a separate cataract operation, speeding up your recovery.

Is the eye painful after surgery for epiretinal membrane?

No. Your eye will feel a little gritty, dry and sore for a few days, but not painful.

Can eye drops be used to treat epiretinal membrane?

Unfortunately, eye drops cannot be used to treat epiretinam membrane.

Does eyesight return completely back to normal after vitrectomy for epiretinal membrane?

The vast majority achieve improvement in eyesight after surgery. Some visual distortion or blurriness often remains, as there will be some irreversible damage to the retina at a microscopic level prior to surgery, due to the length of time an epiretinal membrane has been crinkling and distorting the macula. Thus, it is helpful to seek the attention of a retinal surgeon early before extensive irreversible damage has occurred. The best visual result is achieved when surgery is performed before vision is severely affected.

Your retinal surgeon is best placed to determine if vitrectomy is indicated, and to identify the optimum timing for surgery to achieve the best possible result.

Can epiretinal membrane cause blindness?

No, an epiretinal membrane on its own does not cause complete blindness. However, certain underlying causes of epiretinal membrane can threaten sight, and need to be excluded by a retina specialist.

Epiretinal membrane affects central or fine vision, sometimes quite severely. Peripheral vision remains unaffected.

Why chose OCL Vision for your epiretinal membrane treatment?

Expert in complex retinal surgery

Our retina surgeon Mr Chien Wong is highly experienced in complex retinal surgery. He is among a handful of ophthalmologists in the world with a super-speciality practice in complex paediatric vitreoretinal surgery and retinovascular diseases.

Leaders of retinal surgery innovation

Our team of retinal specialists are leaders in their field, pioneering technical advances in vitreoretinal surgery. Their expertise is sought internationally by vitreoretinal surgical companies to advise on improvements of current and future technologies in order to optimise the safety and effectiveness of surgery.

Treatment tailored for you

You are always at the centre of everything we do. We do not offer a one size fits all approach but rather customise every single treatment to your individual visual needs, so you’ll always get the best procedure for your eyes and your vision.

Exceptional patient feedback

We are results orientated, providing unrivalled safety and precision with our treatments. We care about what we do and the people we treat, and that shows in our Trustpilot rating of 9.9/10.