Epiretinal Membrane Macular Pucker

Overview

An epiretinal membrane is a thin layer of scar-like tissue that grows on the surface of the macula. The macula is the small area at the centre of the retina, at the back of the eye, that gives you sharp, detailed vision for reading and recognising faces. When this tissue forms, it can shrink and wrinkle the macula, like a piece of cling film pulling on the surface. This wrinkling is why it is also called a macular pucker. It usually affects one eye, though both eyes can be involved.

Yes, it is quite common. It is seen most often in people over the age of 50, and mild forms are found in a number of older adults during routine eye checks, sometimes without causing any symptoms at all.

It mostly affects older adults, and becomes more common with age. It can also happen after eye surgery, after a retinal tear or detachment, or in people with certain eye conditions such as inflammation inside the eye or diabetic eye disease. It is uncommon in children and young adults.

Symptoms

Common symptoms

• Blurred or slightly fuzzy central vision
• Straight lines looking wavy or bent (this is called metamorphopsia)
• Difficulty reading small print, or letters seeming to jump or run together
• Needing more light to see clearly
• Objects looking slightly distorted or a different size in one eye compared with the other
• A mild greying or dimming of central vision, while side (peripheral) vision stays normal

Symptoms in children

• Epiretinal membrane is rare in children. When it does happen, young children may not be able to describe their symptoms.
• Possible signs include squinting, holding things closer, rubbing the eyes, or difficulty with schoolwork that involves reading the board or books.
• A child whose vision is not developing normally should always be checked by an eye specialist.

Symptoms in older adults

• Gradual blurring or distortion of central vision that may be noticed first when reading, driving or watching television
• Difficulty telling similar colours apart, or colours looking slightly faded
• Vision that seems worse in low light or when tired
• In many older adults the changes stay mild and stable for years

Causes

Main causes

• Most cases happen as the clear jelly inside the eye (the vitreous) naturally shrinks and pulls away from the retina with age. The healing response leaves a thin layer of cells on the macula surface, which forms the membrane.
• Sometimes the membrane forms after a retinal tear, retinal detachment, or eye surgery such as cataract surgery.
• It can also be linked to inflammation inside the eye, bleeding inside the eye, or other eye conditions that cause ongoing irritation of the retina.

Risk factors

• Getting older, especially over 50
• Having had cataract surgery or other eye surgery
• Having had a retinal tear or retinal detachment
• Diabetic eye disease or other conditions that affect the blood vessels in the eye
• Inflammation inside the eye (uveitis), or previous injury or infection in the eye
• Having the condition in one eye, which slightly raises the chance of it developing in the other eye later

When to see a doctor

See a doctor urgently if:

• A sudden drop in vision, or a shadow or curtain across your sight
• A sudden burst of new floaters or flashing lights
• Vision in one eye becoming much worse or more distorted very quickly
• Pain, redness or swelling in the eye, especially after eye surgery

Book a routine appointment if:

• Straight lines look wavy or bent when you check them one eye at a time
• Central vision is blurry or distorted and it is affecting reading, driving or everyday tasks
• You need brighter light than before to read or see detail
• You have noticed a change in how colours look, or that one eye sees differently from the other
• You have diabetes or a history of eye surgery and notice any change in your sight

Diagnosis

An eye doctor (ophthalmologist) or optometrist can usually spot an epiretinal membrane by looking carefully at the back of your eye. They will ask about your vision and may use special eye drops to widen (dilate) your pupils so they can see the macula clearly. A scan called OCT is often used to take detailed pictures of the layers of the retina, which shows how much the membrane is pulling on the macula.

Tests that may be done

• A vision test using a letter chart, one eye at a time
• An Amsler grid test, where you look at a grid of straight lines to check for wavy areas
• Dilated eye examination, using eye drops to widen the pupil so the retina can be seen
• Optical coherence tomography (OCT), a quick, painless scan that takes cross-section pictures of the retina
• Sometimes a photograph or dye test of the retina to look at the blood vessels and how the macula is working

What to expect at your appointment

The tests are quick and do not hurt. The drops used to widen your pupils can make your vision blurry and your eyes sensitive to light for a few hours, so it helps to arrange a lift home or bring sunglasses. You may be offered a follow-up appointment in a few months to see whether anything is changing, since many membranes stay stable.

Treatment

Treatment depends on how much your vision is affected and how much it bothers you in daily life. If your sight is good or the changes are mild, the usual approach is to watch and wait with regular eye checks. If distortion or blurring is making everyday tasks hard, surgery may be discussed. There is no eye drop or tablet that removes an epiretinal membrane.

Self-care at home

• Check your vision at home with an Amsler grid, one eye at a time, as often as your eye care team advises, and report any new waviness promptly
• Use good lighting and magnifiers for reading if small print is harder than it used to be
• Keep up regular eye tests, and tell your optometrist about any change in your sight
• Wear sunglasses on bright days if light feels uncomfortable
• Manage other health conditions such as diabetes and high blood pressure, as these affect eye health

Medical treatments

There are no medicines, eye drops or injections that can dissolve or remove an epiretinal membrane. Your eye care team will monitor you with regular check-ups and scans, and will talk with you about whether watching and waiting is still the right choice. If your vision worsens to the point where daily activities become difficult, they may refer you to a retinal surgeon to discuss an operation. Some people with swelling of the macula may be offered treatment by an eye specialist, but this is decided case by case.

When is surgery considered?

Surgery may be suggested when blurring or distortion in the eye is clearly affecting everyday life, such as reading, driving or recognising faces, and when the scans show the membrane is pulling on the macula. The operation is called vitrectomy with membrane peel: the jelly inside the eye is removed and the thin membrane is gently lifted off the macula. It is usually done as day surgery under local anaesthetic. Vision usually improves slowly over months, though some distortion can remain, and there are risks such as cataract forming faster, infection, or retinal detachment. Your surgeon will explain the benefits and risks for your situation.

Living with this condition

Most people carry on with their normal routine. You may need to adapt a little, such as using brighter lights, larger print, or holding reading material further away. Because the condition usually affects one eye, your other eye often makes up for a lot, which is why some people notice the problem only when they cover the good eye. Regular checks help you and your eye care team keep track of any changes.

Lifestyle tips

• Keep reading and doing the hobbies you enjoy; using larger print, audiobooks or good task lighting can help
• Have regular eye tests, and tell your optometrist about any new distortion or blurring
• If you drive, check with your eye care team that your vision still meets the legal standard for driving
• Keep other health conditions well managed, including diabetes and blood pressure
• Give yourself time to adjust, and ask about low vision support if everyday tasks become harder

Diet and exercise

There is no special diet or exercise that treats an epiretinal membrane. Eating a balanced diet rich in vegetables and fruit, staying active, not smoking and keeping blood pressure and blood sugar in a healthy range all support general eye and blood vessel health. Always check with your doctor before starting a new exercise plan, especially if you have other health conditions.

Mental health and emotional wellbeing

Changes in your sight can be unsettling, and it is normal to feel worried or frustrated, especially if reading or driving becomes harder. Talk to your eye care team about what to expect, because understanding the plan often eases anxiety. If low mood, worry or stress is affecting your daily life, tell your doctor. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis support service straight away.

Prevention

There is no proven way to prevent an epiretinal membrane, because most cases are linked to the natural ageing of the eye. You can support your eye health by not smoking, keeping blood pressure and blood sugar in a healthy range, wearing eye protection for risky tasks, and having regular eye tests so any changes are picked up early.

Screening programmes

There is no national screening programme for epiretinal membrane. Regular eye tests, usually every two years or as advised by your optometrist, are the best way to detect changes early. People with diabetes are usually offered yearly eye screening, which also looks at the back of the eye.

Complications

If left untreated

• Vision may become more blurred or distorted over time, though many membranes stay stable for years
• Swelling of the macula can develop, which can further reduce central vision
• A hole may form in the macula in rare cases, which can cause a noticeable blind spot in the centre of vision
• Everyday tasks like reading, driving and recognising faces can become harder

Long-term outlook

The outlook is generally good. Many people with an epiretinal membrane keep useful vision without any treatment, and for those who need surgery, most notice improvement over months, though it can be gradual and some distortion may remain. Regular eye checks mean any change can be picked up and discussed early, so you can make the choice that is right for you.

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