Epiretinal membrane (ERM), also known as macular pucker or cellophane maculopathy, is a condition where a thin, semi-clear membrane forms on the inner surface of the retina, often impacting the macula. This membrane can lead to vision changes, though some individuals experience no noticeable symptoms.
Understanding Epiretinal Membrane
Epiretinal membrane is a delicate, fibrous layer that develops directly on the surface of the macula, the specialized central area of the retina. The macula is responsible for sharp, detailed central vision, necessary for tasks like reading and recognizing faces. As it forms, the membrane can contract, exerting traction on the underlying macular tissue. This pulling or wrinkling effect primarily leads to visual disturbances. The membrane is a separate entity from the retinal tissue itself.
Why ERM Develops
Epiretinal membrane often develops without a clear identifiable cause, known as idiopathic, and is frequently associated with the natural aging process of the eye. Other cases of ERM are secondary, arising from pre-existing eye conditions or events. These include posterior vitreous detachment, a common age-related process where the vitreous gel separates from the retina. Diabetic retinopathy, retinal vascular diseases like vein occlusions, and direct eye trauma are also contributors. Inflammation within the eye can similarly trigger the cellular changes that lead to membrane formation.
Symptoms of ERM
Many individuals with an epiretinal membrane experience no symptoms, especially when the membrane is thin or located away from the macula’s center. When symptoms do manifest, they often involve changes in central vision.
Blurred vision is a common complaint, making it difficult to discern fine details. A hallmark symptom is metamorphopsia, where straight lines, such as doorframes or grid patterns, appear wavy, bent, or distorted. Some people may also notice a gray area or a small blind spot in their central field of vision. Sensitivity to light can also occur, and the severity of these symptoms varies significantly among affected individuals.
Detecting and Treating ERM
Diagnosis of an epiretinal membrane begins with a thorough eye examination by an ophthalmologist. Optical coherence tomography (OCT) is a primary diagnostic tool, providing high-resolution cross-sectional images of the retina. This imaging allows the eye care professional to visualize the membrane, assess its thickness, and determine the extent of any traction or wrinkling on the macula.
Treatment is primarily surgical and is considered only when the ERM causes significant visual impairment. The main surgical procedure is a vitrectomy with membrane peel. During this procedure, a small incision is made in the eye to remove the vitreous gel, and the thin epiretinal membrane is carefully peeled away from the macular surface. The surgery aims to relieve traction on the macula, which can lead to improved vision and reduced distortion, though full recovery of vision may not always occur.