An epiretinal membrane is a thin layer of fibrous tissue that can grow over the macula in the centre of the retina, at the back of the eye. It can affect the central vision we use for detailed tasks like reading. It's also known as macular pucker, macular fibrosis, surface wrinkling retinopathy, and cellophane maculopathy.
Epiretinal membrane (ERM) is a painless condition that happens when a thin sheet of cell tissue develops over the macula at the back of the eye. It's most common among people aged 50 and over. For many people, it doesn't cause symptoms. But it can affect your central vision, causing blurring and distortion and reducing visual acuity (measured by how many lines you can read on the chart in an eye test). If you're not experiencing symptoms that interfere with daily life, you may not need treatment. But if you do, surgery can help improve your vision.
Epiretinal membrane symptoms
An epiretinal membrane can often develop without causing symptoms that affect your vision. You might not even be aware of the condition until it's detected at a routine eye test. The scar tissue that grows over the retina’s surface may not cause symptoms. However, when it stops growing, it can shrink, and the retina underneath can become wrinkled. This can interfere with your central vision causing symptoms such as:
- Distorted vision causing straight lines or objects to appear wavy or crooked (known as metamorphopsia).
- Difficulty with reading and seeing fine details.
- Worsening visual acuity (you're able to read less of the eye test chart used by opticians).
- Less common symptoms can include double vision and sensitivity to light.
Epiretinal membrane treatments
Many people with epiretinal membrane don't need treatment, particularly if it doesn't disrupt their vision and everyday life. You will probably have a surgical procedure called a vitrectomy if you need treatment. Symptoms won't get better by wearing prescription lenses or taking eye drops.
Your ophthalmologist will discuss the pros and cons of treatment with you to help you make the best decision for your circumstances. Some people live with epiretinal membrane, especially if the vision in their unaffected eye is good. However, if it starts to get in the way of activities you enjoy or need to do, like reading and driving, surgery may be right for you.
Vitrectomy surgery is a kind of keyhole surgery on the eye. Usually done under local anesthetic, the surgeon will make tiny cuts to the eye, remove the vitreous gel (the jelly-like substance inside the eye), and peel the epiretinal membrane away from the retina. They may then insert a gas bubble into the eye to help healing.
Getting an epiretinal membrane diagnosis
An epiretinal membrane may first be diagnosed at a routine eye test because many people who develop the condition do not experience noticeable symptoms.
An optical coherence tomography (OCT) test can help diagnose epiretinal membrane. It's a quick, non-invasive test that takes a detailed scan of the retinal layers in the eye. You might also have a fluorescein angiography test, which uses a special dye to help examine the retina. The coloured dye is injected into the arm, then travels through the body and can be seen in the blood vessels in the retina by a special camera.
Causes of epiretinal membrane
The most common cause of epiretinal membrane is thought to be an age-related condition called posterior vitreous detachment (PVD). This helps explain why it occurs most often in people over 50.
An epiretinal membrane can also happen due to other conditions or problems with the eye. Risk factors include surgery for retinal detachment, treatment for diabetic retinopathy, retinal tear, and conditions that affect the blood vessels at the back of the eye, such as retinal vein occlusion. Inflammation and eye injury are also less common causes.
When the exact cause of epiretinal membrane isn't known, this is called idiopathic epiretinal membrane (ERMS).
When to get medical advice
Routine eye tests can detect a range of eye conditions before symptoms become apparent. That's one of the reasons the NHS recommends we see an optometrist for an eye test every two years.
Living with epiretinal membrane
Many people can live with epiretinal membrane without having treatment. It may not affect your vision or everyday life. If epiretinal membrane begins to make day-to-day activities harder, for example, reading and driving, speak to your specialist. Get tips and advice for coping with changes to your central vision while living with epiretinal membrane.
Frequently asked questions
Medically reviewed by: The Royal College of Ophthalmologists on 18/10/2022
Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.