What is an Epiretinal Membrane?
Epiretinal Membrane (Macular Pucker): What It Is, What to Expect, and When to Consider Treatment
An epiretinal membrane — also called a macular pucker, cellophane maculopathy, or premacular fibrosis — is a thin layer of scar-like tissue that forms on the surface of the macula, the central portion of the retina responsible for sharp, detailed vision. As this membrane contracts, it can cause the underlying retinal tissue to wrinkle or pucker, distorting the way light is focused and affecting central vision.
Epiretinal membrane is more common than most patients realize. It occurs in approximately 2% of people over age 50 and up to 20% of people over age 75, and it is a frequent incidental finding on routine retinal imaging even in patients who have no noticeable visual symptoms.
What Causes an Epiretinal Membrane?
In most cases, epiretinal membranes develop as a consequence of posterior vitreous detachment (PVD) — the age-related process in which the gel inside the eye separates from the retina. During or after this separation, cells from the retinal surface can migrate onto the macular surface and proliferate, forming the thin fibrous membrane. Less commonly, epiretinal membranes develop secondary to other ocular conditions including prior retinal tears or detachment, uveitis, diabetic retinopathy, retinal vascular disease, or previous eye surgery.
Symptoms
Epiretinal membranes exist on a spectrum. Mild membranes may cause no symptoms whatsoever and are discovered only on routine examination or OCT imaging. As the membrane becomes more pronounced or contracts more significantly, patients may notice blurred or hazy central vision, distortion or waviness of straight lines (a symptom called metamorphopsia), difficulty reading fine print, and occasionally a mild reduction in central visual acuity. Double vision in one eye (monocular diplopia) is a less common but recognized symptom.
Symptoms typically affect only one eye, though epiretinal membranes can occur in both eyes. Progression is usually slow, and many patients remain stable for years without worsening.
Diagnosis
Epiretinal membrane is diagnosed through a comprehensive dilated eye examination. Optical coherence tomography (OCT) — a non-invasive retinal imaging technology — is the gold standard for evaluating the membrane’s characteristics, thickness, and degree of retinal distortion, and for monitoring changes over time. OCT allows very precise assessment of the membrane and guides surgical decision-making.
Treatment: Watchful Waiting vs. Surgery
Many patients with epiretinal membrane require no immediate treatment. When vision is only mildly affected and the condition is stable, careful monitoring with periodic examination and OCT imaging is the appropriate approach. There are currently no eye drops, medications, or laser treatments that dissolve or remove an epiretinal membrane.
For patients whose vision is significantly impaired by the membrane — particularly those with meaningful metamorphopsia, difficulty reading, or progressive visual decline — surgical treatment is available. The procedure, called pars plana vitrectomy with membrane peeling, is performed by a vitreoretinal surgeon (a subspecialty ophthalmologist) in an operating room setting. During the procedure, the vitreous gel is removed and the epiretinal membrane is carefully peeled from the retinal surface using microscopic instruments. The surgery is highly effective at reducing distortion and improving or stabilizing visual acuity in appropriately selected patients, though recovery of vision occurs gradually over months.
At River City Eye Associates, Dr. Hager evaluates patients with epiretinal membrane, monitors disease progression with serial OCT imaging, and coordinates referral to a trusted retinal surgical specialist when treatment is indicated. If you have been told you have a macular pucker or epiretinal membrane, or if you are experiencing central visual distortion, contact our San Antonio office at 210-930-2015 to schedule a comprehensive evaluation.