Epiretinal Membrane

What is Epiretinal Membrane (ERM)

The Epiretinal Membrane is a delicate sheet-like tissue or membrane that forms on top of the retina or back of our eyes. When it forms over the macula which is the central part of retina, it can cause distortion or blurry vision.

Symptoms of an Epiretinal Membrane

Patients with an epiretinal membrane may experience varying degrees of vision changes or blurred vision in the affected eye/s. This is usually painless.

Symptoms of an epiretinal membrane include:

• Blurred vision
• Difficulty seeing fine detail or reading small print
• Double vision
• Distorted and wavy image particularly in the centre of field of vision
• Appearance of a grey area or blind spot in the centre field of vision
• Even if one eye is closed these symptoms may still occur in the open eye

In a few cases, no noticeable change in vision is apparent with the presence of an epiretinal membrane however it is recommended that all patients diagnosed with an epiretinal membrane are seen by the consultant to determine if treatment is needed.

Causes of an Epiretinal Membrane

Epiretinal membranes usually occur naturally as part of the ageing process. As we get older, the vitreous gel inside the eye slowly lessens and shrinks thus pulling away from the surface of the retina. For a few, the pulling away from the retina causes a small amount of damage. This is caused by the thin layer of scar tissue that forms. When this scar tissue reaches the macula and forms over the top of the macula it blurs and distorts the central field of vision.

Epiretinal membranes commonly affect patients with no previous history of eye problems. However, there are higher risk groups for developing an epiretinal membrane.

These include:

• Adults over 60 years old
• Occasionally an eye injury can trigger an epiretinal membrane.
• Anyone with a history of diabetic retinopathy, retinal detachment, retinal tear, retinal vein occlusion, or uveitis
• Previous laser treatment in retina for example to cover tear or retinopathy

Diagnosing an Epiretinal Membrane

An epiretinal membrane will usually be diagnosed with a consultation by a retinal specialist and can be spotted most obviously by an Optical Coherence Tomography (OCT) Scan. Together this will determine the presence of an epiretinal membrane, the cause and the treatment required.

This consultation will involve:

• Examination of both eyes with dilating eye drops to see further into the back of your eye with a slit lamp.
• Optical Coherence Tomography (OCT) Scan is the most important diagnostic for detailed assessment. This allows the specialist to understand the severity of the condition.

Once we have diagnosed you with epiretinal membrane we will create a customised plan to treat the condition.

How to Treat Epiretinal Membrane & Epiretinal Membrane Peeling

This condition may be monitored closely with series of macula scanning until effect vision when a surgical treatment can be indicated. An epiretinal membrane peel is a procedure for removing the scar tissue over the macular (the central part of the retina). This procedure is often done with a vitrectomy surgery.

During an epiretinal membrane peeling, the surgeon will make several small incisions on the sclera to remove the vitreous gel for easy access to the retinal layer. The surgeon will use the micro-forceps to carefully peel off the epiretinal membrane from the macula. The last step is placing a small gas bubble into the eye to hold the retina in place as it heals.

In most epiretinal membrane peels, the surgeon doesn’t need to place sutures since the instruments used in the procedure are extremely precise with minimal incisions. This results in minimal discomfort during recovery. This procedure is now perform routinely for people with significant reduce vision or distorted vision.

Recovery Following Epiretinal Membrane Peel

After your epiretinal membrane peel, swelling and discomfort may occur. The surgeon will prescribe medications to reduce the discomfort. You will also get a series of antibiotic and anti-inflammatory eye drops for the affected eye/s. Ensure you adhere to the surgeon’s instructions for the frequency and duration of administering the drops. The recommended period for using the prescribed drops varies between patients.

Immediately after the procedure, you will have an eye patch, but the technician will remove the eye patch the next day during your first post-operative appointment. However, you need to wear the eye patch before sleeping for at least two weeks after the procedure to protect your eyes and aid recovery.

You may need to keep the gas bubbles in place until a seal forms around the treated retina. Some people have to place their eyes and head in a certain position for at least 90% of the day within the first 1 – 3 weeks.

Avoid lying on your back to prevent the bubble from moving to the eye surface and pressing against the lens to cause other issues.

Ensure you do the following in the first two weeks following your epiretinal membrane peel:

• Avoid air travel
• Avoid driving
• Avoid lifting weights weighing over 5 – 10 lbs
• Avoid activities involving bending your waist, including sports, household chores, and exercise
• Avoid using hot tubs, bathtubs, lakes, and pools. You can shower, but cover your eyes to prevent water from entering them
• Avoid reading or using a computer, including smartphones and tablets.
• You can watch TV since it requires less eye strain and movement but remain at least 6 feet away from the television.

Blurred vision for near and distant objects usually occurs 4 - 6 weeks after your retinal surgery. Your vision will gradually improve over time.

Ensure you contact your doctor if you experience the following after your epiretinal membrane peel.

• Increasing pain
• A sudden reduction in vision
• Light sensitivity
• Eye discharge besides watering
• Increasing redness
• Light flashes
• Changes in your visual field
• New floaters

If you notice changes in your near vision and think you need the epiretinal membrane peel procedure, visit Optimal Vision for a consultation with our eye surgeons.

You can contact us now on 020 7183 3725 to schedule an appointment.