Epiretinal membrane: All you need to know

Epiretinal membranes are thin, translucent fibrous tissue layers that create a film on the retina’s inner surface.

Epiretinal membranes (ERMs) are more common in people over 50 years old. According to the American Society of Retina Specialists (ASRS), ERMs affect at least 2% of people over 50 and 20% of people over 75, but the majority do not require treatment.

Up to 20% of people with ERMS experience symptoms in both eyes; however, the degree of each eye’s symptoms varies.

Causes and risk factors

blurred vision
Severe occurrences of ERM can cause blurred and distorted vision.

The likelihood of having an ERM rises with age, and people who already have an eye or visual condition may develop one before they are 50.

The following eye diseases put a person at risk for acquiring an ERM:

  • Surgery: Eye surgeries, such as cataract surgery, can cause ERMs.
  • Retinal vascular diseases: Conditions affecting the blood vessels in the eyes, such as diabetic retinopathy. Diabetic retinopathy can affect people with diabetes
  • Existing ERM: Having an ERM in one eye means a higher likelihood of getting them in the other eye too.
  • Posterior vitreous detachment: Separating of the gel that fills the back of the eye to the retina.
  • Retinal tear or detachment: A retinal tear is a break in the retina whereas retinal detachment occurs when the retina pulls away from the back of the eye.
  • Injuries: Eye injuries or traumas can cause ERMs.

Having ERM risk factors does not ensure that an eye will develop the condition in one or both eyes. Also, even if there are no risk factors, an ERM might form.

Who receives ERMs?

Men and women are equally affected by ERMs, according to the ASRS, although at least one medical journal disagrees. Women are more affected by ERMs than males, according to a study published in the journal BMJ Open.

It’s also likely that some races are more affected than others by this condition. According to the BMJ, 39 percent of those affected by this disease were Chinese, 27.5 percent were Caucasian, 26.2 percent were African, and 29.3 percent were Hispanic.

Diagnosis

a routine eye exam

ERMs are detectable during a standard eye checkup. The majority of the time, eyesight is unaffected. The majority of ERMs do not alter and do not cause visual problems.

However, some ERM worsens with time, causing blurring and visual problems. Only when there are visual symptoms will a doctor recommend therapy.

The identification of ERMs can be aided by a diagnostic technique called optical coherence tomography (OCT), which employs light waves to scan and observe the layers of the retina.

Another test called fluorescein angiography may be used by an eye doctor. A dye is used to light up parts of the retina in this examination.

Treatment

There are no other viable therapies for ERMs outside surgery. Treatments such as glasses or contacts, as well as prescription eye drops, are ineffective.

According to a study published in the Indian Journal of Ophthalmology, around 15% of ERMs require surgery. Furthermore, surgical surgery is successful in the vast majority of instances, despite the fact that vision recovery for 25 to 50% of patients is around 20/40.

Visual accuracy, clarity, and sharpness are all defined by the 20/40 test. A 20/40 vision measurement indicates that someone can see at 20 feet (ft) what someone with normal vision can see at 40 feet.

Vitrectomy surgery procedure

A vitrectomy is the procedure used to treat ERMs. The surgeon will make microscopic incisions in the affected eye and remove the fluid from inside the eye during a vitrectomy.

The surgeon will next press the epiretinal membrane against the retina and gradually pull it away from the retina, replacing the fluid in the eye.

Finally, the doctor covers the eye with a pad and covering to prevent infection or harm.

Risks for EMR surgery

Vitrectomy surgery carries a number of dangers. ERM surgery causes the risk of cataract, an eye condition in which the lens of the eye becomes clouded.

In general, however, the risk of ERM surgery is negligible. According to the ASRS, around one in every 100 people suffers from retinal detachment, and 1 in every 2,000 suffers from a post-surgical infection.

Recovery after ERM surgery

The person will be given eye drops following surgery to help stabilize the eye, and the surgical personnel will provide instructions on how long they should use the drops.

Most vitrectomies are performed as outpatient procedures, meaning the patient will not be required to stay in the hospital overnight.

After surgery, they’ll need another adult to drive them home.

Following a vitrectomy, a person may be required to hold their head in a specific posture for part of the day, at least for a few days. To facilitate a speedy recovery, the surgeon will offer recommendations on how to minimize activities. After surgery, most people will notice a difference in their vision, but it may take up to three months for their eyesight to settle.

Prevention

There are no safeguards in place to prevent the development of an ERM. An ERM can occur as a result of another retinal disease, such as diabetic retinopathy, therefore controlling an underlying condition, such as diabetes, can help avoid an ERM in one or both eyes.

Conclusion

The majority of people who develop an ERM have a favourable prognosis. Many people’s visual problems are modest and may not influence their quality of life or necessitate therapy. Surgery is typically successful in improving eyesight for patients who require surgery due to advanced ERM, and complications related with ERM surgery are uncommon.

Sources:

  • https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0027340/
  • http://eyewiki.aao.org/Epiretinal_Membrane
  • https://www.asrs.org/patients/retinal-diseases/19/epiretinal-membranes
  • https://nei.nih.gov/health/pucker/pucker
  • https://www.medicalnewstoday.com/articles/319736
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070851/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064239/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820189
  • http://bmjopen.bmj.com/content/7/9/e014644

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