ConditionEyes & vision
Epiretinal Membrane
An epiretinal membrane (ERM) is a thin, transparent layer of scar tissue that forms on the surface of the macula, the part of the retina responsible for sharp central vision. As it contracts, it can wrinkle the retina, causing blurred or distorted vision in which straight lines look wavy. It is common after age 50, usually follows a normal age-related change in the eye's gel, and is often mild enough to need no treatment. When vision is significantly affected, a vitrectomy operation can peel the membrane away.
Also called: ERM, macular pucker, cellophane maculopathy, preretinal macular fibrosis, surface wrinkling retinopathy
At a glance
- What it is
- A thin scar-like membrane on the macula that can wrinkle the retina.
- Who gets it
- Mostly people over 50; often after posterior vitreous detachment.
- Symptoms
- Mild blur, distortion (wavy lines), difficulty reading fine print; often none.
- Diagnosis
- Dilated eye exam and optical coherence tomography (OCT) scan.
- Treatment
- Monitoring; vitrectomy with membrane peel when vision is bothersome.
When to get help
Call 911 or go to the ER
- A sudden shower of new floaters, flashes of light, or a curtain or shadow over part of your vision (possible retinal tear or detachment)
- Sudden loss of vision in one eye
See a doctor within a day or two
- Rapid worsening of distortion or a new dark or missing spot in central vision
- Painful red eye or severe light sensitivity after eye surgery
Book a routine appointment
- Straight lines looking wavy or bent, or objects looking larger or smaller in one eye
- Gradually blurred central vision that glasses do not correct
- Double vision in one eye or difficulty reading
What happens in the eye
The back of the eye is filled with a clear gel called the vitreous, which is attached to the retina. With age, the vitreous shrinks and pulls away from the retina, a normal change called posterior vitreous detachment (PVD). In some people, cells are left behind on the retinal surface or migrate there, and they grow into a thin membrane.
The membrane can be:
- flat and stable, causing little effect ("cellophane" sheen on examination)
- contracting, which wrinkles and thickens the macula ("macular pucker") and distorts vision
Symptoms
Many epiretinal membranes cause no symptoms and are found during routine eye exams. When symptoms occur, they usually develop slowly in one eye:
- blurred central vision, not corrected by glasses
- distorted vision (metamorphopsia): straight lines such as door frames or text look wavy or bent
- objects looking larger or smaller in one eye than the other
- double vision in the affected eye
- difficulty reading fine print or seeing detail
- a gray area or blur in the center of vision
Side vision is not affected. ERMs do not cause total blindness.
Causes and risk factors
- idiopathic (age-related): the most common type, linked to PVD, usually after 50
- retinal tears and retinal detachment, and surgery to repair them
- diabetic retinopathy and retinal vein occlusion
- inflammation inside the eye (uveitis)
- eye trauma
- previous eye surgery, including cataract surgery or laser treatment
Both eyes are affected in a minority of people.
Epiretinal membrane vs macular hole vs macular degeneration
| Epiretinal membrane | Macular hole | Macular degeneration | |
|---|---|---|---|
| Cause | Scar on macular surface | Full-thickness defect in the macula | Degeneration of macular cells and support layers |
| Main symptom | Distortion, mild blur | Central dark spot, distortion | Central blur, dark spots, distortion (wet type) |
| Progression | Often stable or slow | Usually progressive without surgery | Gradual (dry) or rapid (wet) |
| Treatment | Monitoring or vitrectomy | Vitrectomy with gas bubble | Supplements (dry), eye injections (wet) |
Diagnosis
- Visual acuity testing
- Amsler grid: a grid of straight lines that shows distortion
- Dilated eye examination, where the membrane may appear as a glistening sheen or wrinkled surface
- Optical coherence tomography (OCT): a quick, non-contact scan that shows the membrane and retinal thickening in cross-section. It is the key test for diagnosis, monitoring and surgical planning
Treatment
Watchful waiting
Most ERMs remain stable for years. If vision is good and distortion is mild, no treatment is needed. Your eye doctor may recommend periodic checks and home monitoring with an Amsler grid. Glasses do not fix the distortion but may help overall clarity.
There are no eye drops, supplements or laser treatments that remove an ERM.
Surgery: vitrectomy with membrane peel
Surgery is considered when blurred vision or distortion interferes with reading, driving or work. A retina surgeon:
- removes the vitreous gel through tiny ports in the white of the eye (vitrectomy)
- gently peels the membrane off the macula with fine forceps, often with a dye to make it visible
- sometimes also peels the inner limiting membrane to reduce recurrence
It is usually done under local anesthesia as day surgery.
Recovery and results
- vision improves gradually over 3 to 6 months, sometimes longer
- most people see less distortion and better clarity, though vision often does not return completely to normal
- earlier surgery, before vision drops greatly, tends to give better results
- cataract commonly develops or worsens within 1 to 2 years after vitrectomy in people over 50, and may need surgery
- less common risks include retinal tear or detachment, infection, raised eye pressure and recurrence of the membrane
Frequently asked questions
What is an epiretinal membrane?
It is a thin layer of scar tissue that forms on the surface of the macula, the center of the retina. When it contracts, it wrinkles the retina and can blur or distort central vision. It is also called macular pucker.
Can an epiretinal membrane go away on its own?
Rarely, a membrane separates from the retina on its own, but most stay in place. Many remain stable for years and do not need treatment. Surgery is the only way to remove one that affects vision.
Can an epiretinal membrane cause blindness?
No. An epiretinal membrane affects only central vision and does not cause complete blindness. Side vision remains normal. Even when vision is significantly affected, surgery can usually improve it.
When is surgery needed for an epiretinal membrane?
Surgery is considered when blurred or distorted vision interferes with daily activities such as reading or driving. The decision is based on your symptoms, vision tests and OCT scans, and is made together with your retina specialist.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: What is a macular pucker?
- American Society of Retina Specialists: Epiretinal membrane (patient fact sheet)
- National Eye Institute: Macular pucker
- MedlinePlus: Retinal disorders
- Royal College of Ophthalmologists: Epiretinal membrane patient information