What Is an Epiretinal Membrane?
An epiretinal membrane (ERM)—sometimes called a macular pucker, cellophane maculopathy, or a wrinkle on the retina—is a common eye condition, especially as we age. While the name may sound intimidating, the condition is often manageable, and treatment, if needed, is highly effective.
Understanding why ERMs form, how they affect vision, and what treatment options exist can provide clarity, reassurance, and practical guidance so you feel informed and confident in your care.
Understanding the Macula: Why This Area Matters
To understand epiretinal membranes, it helps to know a bit about the macula.
The macula is the central part of your retina at the back of your eye. It is responsible for sharp, detailed central vision—the type you use for reading, driving, and seeing fine details.
When something disrupts the macula, your central vision can become distorted or blurred. An epiretinal membrane is one of the most common causes of this type of disruption.
What Exactly Is an Epiretinal Membrane?
An epiretinal membrane is a thin layer of scar tissue that forms on the inner surface of the retina, directly over the macula. Although extremely thin, it can distort the surface of the macula, creating what we call a wrinkle or pucker.
Think of the macula as a flat surface, like a smooth piece of paper. An ERM creates distortion on that surface, causing it to wrinkle—much like crumpling a piece of paper. As the retina becomes distorted, the images you see may also appear distorted.
What Causes Epiretinal Membranes?
1. Age-Related Vitreous Separation
Inside the eye is a gel-like substance called the vitreous. Over time, the vitreous naturally shrinks and separates from the retina—a process called posterior vitreous detachment (PVD). (See our previous article explaining PVD.)
This process can sometimes irritate the retinal surface and cause small cells or proteins to accumulate. These cells can multiply and form a thin membrane.
This is the most common cause of ERM and is part of normal aging.
2. Secondary Causes
Less commonly, ERMs can form after retinal tears or detachment, inflammation, eye trauma, diabetic retinopathy, vein occlusions, or previous eye surgery. In these cases, the membrane forms as part of the eye’s inflammatory response.
Symptoms: What Patients Typically Notice
Symptoms vary depending on the thickness of the membrane and how strongly it tugs on the retina.
Common symptoms include:
- blurry or hazy central vision
- distortion (metamorphopsia)—where straight lines appear wavy
- difficulty reading small print
- a gray spot or area in central vision (scotoma)
- double vision in one eye (monocular diplopia)
These changes usually occur gradually. Some people hardly notice them, while others experience vision that becomes frustrating or limiting.
ERMs, however, do not cause total blindness, severe pain, flashes of light, or peripheral vision loss.
How Epiretinal Membranes Are Diagnosed
A dilated retinal exam and an OCT scan (optical coherence tomography)—a noninvasive imaging test that uses light waves to create high-resolution cross-sectional images of the retina—are the best ways to diagnose an ERM.
OCT clearly shows the membrane and how much the macula is being pulled or distorted. It is also the best way to monitor for progression, allowing advanced comparison analysis to detect subtle changes over time.
Do All Epiretinal Membranes Need Treatment?
Not necessarily. In fact, many epiretinal membranes are mild and don’t require treatment.
Observation
If your symptoms are minimal and your vision is still good, we typically recommend regular monitoring. Many ERMs remain stable for years, and some never progress enough to need surgery.
When Surgery Becomes an Option
Surgery is considered when visual distortion becomes bothersome enough to affect your ability to read, drive, or carry out daily tasks.
The decision is personalized—you and your retina specialist weigh symptom severity, vision goals, and lifestyle needs to determine whether surgery is appropriate.
Treatment: Vitrectomy and Membrane Peeling
The standard treatment for a symptomatic epiretinal membrane is vitrectomy with membrane peeling.
The procedure is typically performed in an outpatient surgery center and often takes less than an hour. During surgery, a specialized dye is injected into the eye to stain the membrane and help the surgeon identify it easily. Small microscopic forceps are then used to gently peel the membrane away from the retinal surface, relieving the traction on the macula.
Recovery Expectations
Most patients resume normal activities within 1–2 weeks. Vision improves gradually over weeks to months. Some distortion may persist if the macula was significantly stretched, but improvement is common.
Cataract progression can occur after vitrectomy in patients who still have their natural lens—something your surgeon will discuss with you.
Success Rates
Vitrectomy for epiretinal membrane has a high success rate, with most patients experiencing reduced distortion, improved clarity, better reading ability, and enhanced overall visual function.
Can Epiretinal Membranes Come Back?
Recurrence is uncommon but can happen, especially if underlying inflammation remains active. Fortunately, recurrent membranes are often milder.
Living with an Epiretinal Membrane
If your ERM is mild and asymptomatic, you may only need periodic exams to ensure stability. Many patients maintain stable vision for years without needing surgery.
If your ERM is more advanced, early evaluation helps ensure you understand your options and decide on the right time for treatment.
Final Thoughts
An epiretinal membrane can sound like a serious diagnosis, but for many people it is a manageable, treatable condition. With modern retinal imaging and advanced microsurgical techniques, most patients achieve excellent outcomes—whether through monitoring or surgery.
If you’ve been diagnosed with an ERM or are experiencing new visual distortion, our retina team is here to support you, answer your questions, and guide you toward the best possible care for your vision.
Contact Associated Retinal Consultants of Arizona
Whether through reassurance, monitoring, or advanced treatment like vitrectomy, our highly trained retina specialists can help you see the world clearly again.
📞 Call: 602-242-4928
📍 Visit: One of our 13 Arizona locations
💻 Request an appointment online: https://associatedretinaconsultants.com