What is an Epiretinal Membrane? (ERM)

An epiretinal membrane is a fibroglial collection of cells which have formed a layer over the retinal surface. Rather like a sheet of cellophane it can contract to scrunch up the underlying retina.

This causes light to unevenly fall on the retina and produces distortion and metamorphopsia in vision (lines on a grid may look curvy or rounded). Epiretinal membranes which have involved the macula are more noticeable as central vision is affected.

This results in distorted vision with both size and the shape of images being affected. It can make reading difficult, and can cause straight lines to be seen as wavy or the words distorted.

What Causes Epiretinal Membrane?

There are many causes of epiretinal membranes. Some are due to previous inflammation in the eye or as a result of a blocked retinal vein, or previous surgery or laser treatment.

A large proportion of epiretinal membranes are idiopathic in nature (they may arise spontaneously). It is more common to develop epiretinal membranes after the age of sixty when the vitreous has separated from the retinal surface leaving an exposed surface for the membrane to grow.

Epiretinal Membrane Eye Wales

How might Epiretinal Membrane Affect my sight?

Some people may not notice the early subtle changes in vision an epiretinal membrane causes. There can be fine differences in image sizes or straight lines becoming progressively wavy.

The most common presentation is that of central vision becoming distorted and is most noticeable when the other eye is covered. Images may be similar to that in a house of mirrors with changes in size and shape of images. In more severe cases there can be a reduction in visual acuity with an inability to see or read in the distance.

In very severe cases the world may appear slanted or at an angle. This can have a significant impact on the quality of vision and on quality of life.

Can Epiretinal Membrane be Treated with Surgery?

The only way to treat epiretinal membrane is with a surgical procedure where the membrane is physically peeled away from the retinal surface. Eye drops or glasses would not be effective as a treatment because the membrane has to be physically removed from the retina. About two thirds of epiretinal membranes progress over time causing persistent symptoms. The decision for surgery does relate to how much the membrane is affecting your quality of life.

To access the membrane safely a Vitrectomy is performed to remove the vitreous, and then, using very fine instruments, the microscopic epiretinal membrane is peeled away. An air or gas bubble is injected into the eye to smooth out the retinal surface. The retina itself has an elastic ‘memory foam’ property which means it can take up to nine months to a year after the membrane has gone for the retina to relax into its natural position. Even after a year often there can be some residual distortion.

 

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