What are epiretinal membranes?

Epiretinal membranes are also referred to as macular puckers. These sometimes develop on the surface of the retina as scar tissue.

As the fibrous scarry tissue develops right over the centre of the retina (called the macula), it can obstruct central and detailed vision. The membrane also pulls on the retinal structure at times, which causes more issues like blurring, distortion, and double vision.

The development of epiretinal membranes

Epiretinal membranes are not uncommon developments from ageing. This is due to what happens in the vitreous in our eyes – the clear gel-like substance that gives our eyes their shape – over time.

As we get older, the vitreous undergoes a variety of changes. These changes can lead to a condition called PVD, which refers to a posterior vitreous detachment.

Essentially, PVD is when the vitreous in the eyes shrinks and pulls away from the retina in the process. Following the separation of the vitreous and retina, there may be scar tissue formation on the latter. That scar tissue is what we call an epiretinal membrane.

This membrane distorts the macular surface from the tension it exerts, pulling on the retina. It may even cause the macula to swell at some point due to that pulling.

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The symptoms of an epiretinal membrane

In its early stages, an epiretinal membrane is very often asymptomatic. That means you will not notice severe changes at the outset.

Over time, however, the membrane will pull on the retina enough to noticeably distort it. When that happens, people with the condition will begin to experience blurry vision. They may even lose central vision later on.

Some have also reported that images appear larger in the eye affected by the condition. Distorted vision is also a common symptom.

On the whole, the symptoms may be fairly variable. Vision loss can range from nonexistent to severe, although the severe end of the scale is rarer.

Risk factors for epiretinal membrane

This condition can happen in healthy eyes with no previous problems, but is also more common if you have had previous eye injuries or surgery. Examples of common risk factors for this are experiences with laser surgery, retinal tears, or retinal detachments.

As mentioned earlier, age is also a critical risk factor thanks to the way it affects our eyes. Studies have supported this, showing that increasing age is significantly associated with early epiretinal membrane.

Other risk factors are possible. Ocular surgery like procedures for cataract treatment may be linked to a higher chance of this problem. Systemic health issues like diabetes and hypercholesterolaemia have both been associated with its development.

This may compound vision-related issues for people with diabetes in particular. They are already more susceptible to conditions like diabetic retinopathy.

Also worth noting is that people with epiretinal membrane in one eye may be more likely to develop it in their other eye.

Treatment for epiretinal membranes

Treatment for epiretinal membranes involves a vitrectomy, a type of keyhole surgery where the vitreous gel in the eye is removed. Only after that can this scar tissue be peeled off from the retinal surface.

That being said, an epiretinal membrane usually requires no treatment. In many cases, the symptoms of blurry vision and vision distortion are very mild and barely progress further.

In the event that treatment is required, surgery is generally the only option. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker.

Surgery is also only recommended when vision deteriorates to the point where it affects daily routine activities. Once the patient reaches that point, a vitrectomy is usually performed under local anaesthesia.

Recovery is generally straightforward for the procedure. The patient will likely need to wear an eye patch for several weeks afterwards and take medicated eye drops to prevent infection.

Risks of surgery

The common risks of epiretinal membrane vitrectomy surgery are retinal tears and haemorrhage, as well as a potentially increased rate of cataract development.

Other risks following the procedure are macular oedema (swelling of the macula) and higher intraocular pressure (pressure in the eye). As with any surgery, infection and inflammation are potential risks as well.

An experienced and conscientious eye doctor should help to reduce the odds of such risks, however. This keeps vitrectomy a viable option for people who actually need epiretinal membrane treatment.