Epiretinal membrane

The macula is the central part of the retina, responsible for the detailed vision we use to read, recognise faces and drive. When a film forms over the macula, it can contract and wrinkle the retina, like crumpled cellophane. Hence the names epiretinal membrane, macular pucker or cellophane maculopathy.

Why does it form?

In most people it is related to ageing of the vitreous, the gel that fills the eye. With age, the vitreous separates from the retina and some cells may remain on the surface of the macula and form the membrane. It is more common after the age of 50. It can also follow a retinal detachment or tear, eye surgery, inflammation, injury or retinal vascular disease such as diabetic retinopathy.

THE MACULA IN CROSS-SECTION

How the membrane distorts vision

The membrane contracts and wrinkles the retina, like crumpled cellophane.

1

Normal retina

The macula has a small central dip, the fovea, where vision is sharpest.

2

With a membrane

The film on the surface pulls the retina, which becomes thick and folded.

3

What you see

Straight lines look wavy or bent, especially in the centre.

What symptoms does it cause?

• Many membranes are thin and cause no symptoms: they are found during a routine examination.
• Blurred or less sharp vision, especially when reading small print.
• Straight lines, such as door frames or tiles, look wavy or bent.
• Objects may look a different size in each eye, and there is sometimes double vision.
• It usually affects one eye. Because the other eye compensates, symptoms may only be noticed when the good eye is covered.

It usually progresses slowly. Many membranes stay stable for years and they rarely go away on their own.

How is it diagnosed?

The membrane can be seen when the back of the eye is examined. Optical coherence tomography (OCT) is the key test: it shows a cross-section of the membrane, the thickening and the folds of the retina, and allows changes to be followed and the timing of surgery to be decided. The Amsler grid helps you monitor distortion at home.

How is it treated?

There are no eye drops or tablets that make the membrane go away. If symptoms are mild, the usual approach is to monitor it with appointments and OCT. New glasses can improve sharpness but do not correct distortion.

When vision or distortion interferes with daily life, surgery is proposed: vitrectomy with removal of the membrane. The surgeon removes the vitreous and, with very fine forceps, peels the membrane off the surface of the macula. Surgery is usually done under local anaesthesia.

What to expect after surgery?

• Improvement is gradual and can take several months. Distortion usually lessens but does not always disappear completely.
• The result depends on how long the membrane has been present and on the state of the retina before surgery.
• In eyes that still have their natural lens, a cataract tends to develop or worsen after vitrectomy. It can be operated on later or during the same surgery.
• If gas is placed in the eye, you may be asked to position your head in the first days and must not fly until the gas has gone.

If you suddenly notice many floaters, flashes of light or a shadow in your field of vision, seek urgent assessment: they may indicate a retinal tear or detachment.

This information does not replace an individual medical assessment. Follow the advice of the team looking after you.