Epiretinal Membrane: Causes, Symptoms and Treatment
What is an epiretinal membrane?
An epiretinal membrane (ERM) is a thin layer of scar tissue that forms on the surface of the macula, the central part of the retina responsible for sharp vision. This membrane can contract and cause distortions in the retina, leading to blurred or distorted vision (metamorphopsia).
An ERM usually develops as a result of natural aging, but can also be caused by other eye conditions such as vitreous detachment, retinal surgery, inflammation or diabetic retinopathy. In most cases, an epiretinal membrane develops gradually and causes mild to moderate visual symptoms. In some cases, however, vision can be significantly affected, necessitating surgical treatment.
Although an ERM does not always require immediate treatment, a vitrectomy may be necessary if the membrane severely affects vision. This procedure removes the vitreous and membrane to relieve stress on the macula and improve vision.
The macula is the center of the retina. Light rays are focused on this part. This part of the retina contains the greatest concentration of photoreceptors and is therefore responsible for perceiving details. The fovea (the center of the macula) is the most important part of the retina.
An epiretinal membrane or macular pucker is a fine layer of scar tissue that forms on the macula. It is like having a translucent cellophane layer on the macula and this will naturally interfere with vision. Because the scar tissue will contract, the underlying retina will also begin to fold. Consequently, the retina's photoreceptors are no longer regularly arranged and the patient will experience distortions of the image.
These distortions are called metamortophoresis. In the case of an epiretinal membrane, there is no real cause. In the case of a secondary membrane, the cause is pre-existing pathology of the eye, such as uveitis (internal inflammation of the eye), laser treatment of the retina or previous surgery.
The symptoms of an epiretinal membrane
An epiretinal membrane (ERM) can lead to various visual symptoms, depending on the severity of the condition. Symptoms usually develop gradually and may worsen over time.
Common symptoms:
- Blurred vision - Vision becomes less sharp, especially when reading or looking at fine details.
- Distorted vision (metamorphopsia) - Straight lines, such as doorways or text, may appear wavy or crooked.
- Double vision in one eye (monocular double vision) - Objects may show a shadow or double outline.
- Reduced contrast perception - Colors and contrasts appear duller, making it more difficult to distinguish subtle details.
- Central spot or blurred area - Some patients experience a bright spot in the center of their vision.
The severity of symptoms varies from person to person. In mild cases, an ERM causes hardly any discomfort, while in more severe forms, daily functioning, such as reading, driving a car or recognizing faces, is hampered. When symptoms increase, surgery (vitrectomy) may be required to remove the membrane and improve vision.
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The causes of an epiretinal membrane
An epiretinal membrane (ERM) results from the formation of scar tissue on the macula, which can lead to blurred and distorted vision.
Causes of an epiretinal membrane
The most common cause is vitreous detachment, a normal aging process in which the vitreous detaches from the retina. Other causes include:
- Retinal surgery or previous eye surgery.
- Eye infections such as uveitis.
- Retinal tears or detachments.
- Diabetic retinopathy or thrombosis in a retinal vein.
- Eye trauma.
Risk factors for an epiretinal membrane
- Age (especially 50+).
- Eye diseases such as macular degeneration or diabetic retinopathy.
- Previous eye surgery or injury.
Treatment of an epiretinal membrane: to operate or not to operate?
An epiretinal membrane can affect vision, but not every patient needs immediate surgery. Treatment depends on the severity of symptoms and the impact on daily life.
For mild symptoms, such as mild distortions or blurred vision, regular monitoring by an ophthalmologist is often sufficient. If visual impairment increases and daily activities, such as reading or driving, become difficult, a vitrectomy may be considered.
During a vitrectomy, the ophthalmic surgeon removes the vitreous and epiretinal membrane, which re-flattens the retina and improves vision. This procedure is usually safe and effective, but the decision to operate is individually tailored to the patient.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Treatment of epiretinal membrane: vitrectomy
If you have marked vision loss and are experiencing metamortorision (imaging), surgery is indicated. This will allow you to improve vision but also stop further vision decline. An epiretinal membrane can be removed via vitrectomy.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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