Epiretinal Membranes (ERM)

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(Also called Cellophane Maculopathy or Macular Pucker)

An epiretinal membrane (ERM) is a thin layer of scar-like tissue that forms on the surface of the retina, specifically over the macula, the area responsible for central, detailed vision. When this membrane contracts or wrinkles, it can distort the underlying retina, leading to blurred or distorted vision.

ERMs are relatively common, especially in people over age 50, and often develop slowly. Many patients have mild ERMs that cause little or no visual disturbance, while others may experience more noticeable symptoms that interfere with daily activities.

 

What Causes an Epiretinal Membrane?

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Most ERMs develop as part of the normal aging process of the eye. Over time, the vitreous gel inside the eye naturally shrinks and separates from the retina — a process called posterior vitreous detachment (PVD). This separation can stimulate microscopic changes on the retinal surface, leading to membrane formation.

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ERMs may be classified as:

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• Idiopathic ERMs – occurring without an identifiable cause (most common)
   

• Secondary ERMs – developing after another eye condition or event
   

Conditions associated with ERM formation include:

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• Retinal tears or detachments
   

• Diabetic retinopathy
   

• Retinal vein occlusions
   

• Eye inflammation (uveitis)
   

• Prior eye surgery (such as cataract surgery)
   

• Eye trauma

 

Symptoms

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Many people with an ERM have no symptoms, especially early on. When symptoms occur, they may include:

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• Blurred or hazy central vision
   

• Distortion of vision — straight lines may appear wavy or bent
   

• Difficulty reading small print
   

• Double vision in one eye (monocular diplopia)
   

• Objects appearing larger or smaller than normal
   

Symptoms typically develop gradually, and peripheral (side) vision is usually unaffected.

 

How Epiretinal Membranes Are Diagnosed

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ERMs are often detected during a dilated retinal examination. Specialized imaging helps confirm the diagnosis and assess severity, including:

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• Optical Coherence Tomography (OCT) – the most important test, providing high-resolution cross-sectional images of the retina to show membrane thickness and retinal distortion
   

• Retinal photography – to document changes over time
   

Regular monitoring is important, as many ERMs remain stable and do not require treatment.

 

Treatment Options

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Treatment depends on symptom severity and impact on daily life.

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Observation

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• Most ERMs do not require immediate treatment
   

• If vision is minimally affected, careful monitoring with periodic exams and OCT imaging is recommended

 

Surgical Treatment

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• For patients with significant vision distortion or decline, surgery may be recommended
   

• The procedure, called a vitrectomy with membrane peeling, involves removing the vitreous gel and delicately peeling the membrane from the retinal surface
   

• Surgery is typically outpatient and performed under local or monitored anesthesia
   

Vision often improves gradually over weeks to months after surgery. While many patients experience meaningful improvement, vision may not return completely to normal, especially if the membrane has been present for a long time.

 

Prognosis

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Most epiretinal membranes are benign and slow-growing. Many patients maintain functional vision without intervention. When surgery is needed, outcomes are generally favorable, particularly when performed before long-standing retinal distortion develops.

ERM recurrence after surgery is uncommon but can occur in a small percentage of patients.

 

Living With an Epiretinal Membrane

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Patients with mild ERMs may benefit from:

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• Updated glasses or magnification
   

• Good lighting for reading
   

• Monitoring vision at home using straight-line patterns or reading tasks
   

Prompt evaluation is recommended if vision suddenly worsens or distortion increases.