A wrinkle on the retina -- which is also known as an epiretinal membrane (ERM) or a macular pucker -- is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina's surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma, or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Do you have floaters in your vision?

Floaters are caused by thick areas in the gel-like fluid that fills the back cavity of your eye, called the vitreous.

Many people, especially highly near-sighted people, often see some degree of floaters for a good portion of their lives. Often, these floaters are in the periphery of your vision and may only be visible in certain lighting conditions. The most frequent conditions are when you are in bright sunlight and are looking toward the clear blue sky. This I know from personal experience as I have a floater in my left eye that I most often see when swimming outdoors. Every time I turn my head to the left to breathe I see this floater moving in my peripheral vision.

This is totally harmless other than when I’m swimming in the ocean and swear that sudden object in my peripheral vision is a shark bearing down on me. Some people who have floaters are not as lucky and the floater can be very central and almost constantly annoying, especially when trying to read.

The second scenario in which floaters occur is during the normal aging process.  The vitreous gel in the back of the eye starts to shrink as we age and at some point it collapses in on itself and pulls away from the retina. This sometimes results in a sudden set of new floaters.

When that happens you need to be checked for signs of a retinal tear or detachment.  As long as your retina survives that episode without any problems, the floaters themselves may stick around for a while and can be rather annoying.  

Most people eventually adapt to the floaters; the brain learns to filter them out so you are no longer aware of them. The vitreous can also collapse more as time goes on and the dense floater you are seeing initially may move further forward and drop lower in the eye so the shadow it is casting is less intense and more in the periphery of your vision where it is much easier to ignore.

The first line of treatment for floaters has been, and still is, to live with them. Once you have your retina checked and there is nothing wrong there, the floaters themselves are harmless and will not lead to any further deterioration of your vision, which is why, if at all possible, you should just live with them. This is especially true if the floaters are new because the overwhelming majority of people with new floaters will eventually get to the point where they are no longer seeing them or at least where they are not interfering with normal daily activities.

If you have tried to wait them out and live with them but they are still interfering with your normal daily activities, you may want to consider having them treated with a laser.

This treatment is relatively new and involves using a special laser to try to break down large floaters into much smaller pieces that may no longer be visible. In a recent study of the laser treatment involving 52 patients, 36 were treated with the laser (a single laser treatment session) and 16 people had a sham treatment (meaning they went through everything the treated group did but did not actually have the real treatment done).  In the people who were actually treated, 54% reported a significant improvement in the floater symptoms while 0% in the sham group reported any improvement (no placebo effect). There were no significant side effects in either group.

Some points to note in the above study:

Fifty-four percent of people treated noted a significant improvement in their floater symptoms with a single treatment. That’s clearly not anywhere near a guaranteed improvement.

Other people have noted an improvement after more than one session, bringing the total expected improvement into the 70% range, with one or more treatments.

Another point to note is that there were no significant side effects to the treatment.

Although true in this small study, it does not mean that there are no risks to the laser treatment. Although rare, there have been reports of damage to the retina, optic nerve, or the lens of the eye. 

Another treatment that can be used to treat floaters is a surgical procedure called a vitrectomy. This involves surgically going inside the back of the eye and removing the vitreous. This surgical procedure carries a higher risk than the laser treatment and is not 100% effective.

In summary, this new laser treatment is a good addition to the tools to deal with significant floater problems. If you have floaters for at least six months and they are central and interfering with your normal daily activities such as reading or driving and you want to see if this laser treatment could be right for you, check with your eye doctor.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

 

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