What is an Epiretinal Membrane?

An epiretinal membrane (ERM) is simply an abnormal membrane or scar tissue that develops on the surface of the retina. It usually develops near or over the macular area that is responsible for your central vision. Epiretinal membranes are quite common with age or in patients with conditions such as diabetic retinopathy, uveitis or after eye surgery. 

Most ERMs are suitable for treatment using modern micro-incision retinal surgery techniques in which I am a specialist. Even if you have good levels of visual acuity but still have symptoms, you can now be treated more effectively and safely than ever before. If you have symptoms, book an appointment with me so we can discuss the best treatment option for you.

ERMs are also called:

  • Cellophane maculopathy
  • Macular pucker
  • Macular pseudohole
  • Lamellar hole
  • Vitreomacular traction due to ERM

What are the Symptoms?

Most ERMs do not cause significant symptoms and remain stable. In some patients, however, ERMs can progress and contract producing wrinkling and thickening of the retina which can cause you to suffer from reduced clarity of vision or distortion when looking at words or people's faces. Straight lines may also appear crooked, and images may appear larger or smaller than they actually are. Occasionally, some people can experience double vision due to an ERM. Some patients may only become aware of these symptoms when covering their good, unaffected eye.  

Most ERMs do not cause significant symptoms and remain stable. In some patients, however, ERMs can progress and contract producing wrinkling and thickening of the retina which can cause you to suffer from reduced clarity of vision or distortion when looking at words or people's faces. Straight lines may also appear crooked, and images may appear larger or smaller than they actually are. Occasionally, some people can experience double vision due to an ERM. Some patients may only become aware of these symptoms when covering their good, unaffected eye.  

Detection

ERMs are often visible when your eye is examined by your optometrist or ophthalmologist doctor. ERMs can also often be seen on photographs of your retina. ERMs are however best detected with the use of specialist retinal imaging equipment known as an OCT scanner. Your optometrist or ophthalmology doctor may already have performed this for you. Your eyecare professional may also have provided you with a special Amsler chart grid to look at periodically, which is useful in detecting progression of your symptoms.  

Should I have Surgery for ERM? What if I leave it?

kam balaggan eye surgery

The only treatment for an ERM is surgical removal. The decision to undertake treatment for your ERM will be based on an in-depth discussion with me to look at many factors including your level of symptoms and your daily visual needs. Most patients will not have symptoms from their ERM, and therefore do not need to undergo surgery.

If you begin to develop symptoms such suchas distortion from the ERM which affect daily tasks such as reading and driving, you should consider surgery. Occasionally, some patients adapt to the distorted vision in their affected eye when they have good vision in their other unaffected eye.  Recent evidence suggests that performing surgery earlier in patients with symptoms may result in better visual outcomes than if surgery is delayed.

If you chose not to undergo surgery, it is important that you self-monitor your symptoms and undergo routine review by your optometrist to detect worsening of your vision or symptoms of distortion.

The only treatment for an ERM is surgical removal. The decision to undertake treatment for your ERM will be based on an in-depth discussion with me to look at many factors including your level of symptoms and your daily visual needs. Most patients will not have symptoms from their ERM, and therefore do not need to undergo surgery.

If you begin to develop symptoms such suchas distortion from the ERM which affect daily tasks such as reading and driving, you should consider surgery. Occasionally, some patients adapt to the distorted vision in their affected eye when they have good vision in their other unaffected eye. Recent evidence suggests that performing surgery earlier in patients with symptoms may result in better visual outcomes than if surgery is delayed.

If you chose not to undergo surgery, it is important that you self-monitor your symptoms and undergo routine review by your optometrist to detect worsening of your vision or symptoms of distortion.

kam balaggan eye surgery

Epiretinal Membrane Surgery

Surgery for the removal of the ERM is called vitrectomy. I exclusively use the latest generation micro-incisional keyhole surgical equipment to perform this operation. Through just 3 tiny incisions, each approximately 0.5mm in length, the vitreous gel is delicately removed from the eye allowing access to the ERM. Using very fine forceps, the ERM is then gently lifted and peeled off from the surface of your macula. This is the most critical and delicate part of the operation.

Removal of the membrane allows the retina to relax and become less wrinkled and thickened. The layer below the ERM may also be peeled to prevent recurrence of the ERM. After this, a sterile air or gas bubble is injected into the eye which naturally absorbs over a period of a few days or up to 2 weeks. Because the incisions required using this specialised keyhole equipment are so small, sutures will not be required in most cases. Routine surgery is usually performed under local anaesthetic and can be performed in as little 20-40 minutes. If you feel you'll be very anxious during the procedure, I have access to an excellent team of private anaesthetists who will be able to administer additional sedation or even general anaesthesia as required, in order to make the procedure as comfortable as possible for you.

 

What Benefit can I Expect from ERM Surgery?

Surgery for ERM has a high success rate. The principal benefit of ERM surgery is an improvement in your symptoms of distortion. About 70-80% of patients will also show an improvement in their vision. Much of these improvements occur within the first 1-2 months following surgery, but further gradual improvements can occur over 12 or more months after surgery. 

The level of improvement depends on several factors:

  1. how badly your vision was affected before surgery and for how long,
  2. whether there are any surgical complications
  3. and the original cause of the ERM. 

Where ERMs develop spontaneously there is generally a better chance of visual recovery compared to ERMs secondary to retinal detachment or retinal vascular disease. Despite the cause, most people will notice improvements in vision. Sometimes, vision may not improve due to irreversible damage caused by the ERM or other causes. Rarely, vision can be worse following surgery. For most people, vision will not return to 100% normal. In about 10% of patients, the ERM can recur which may or may not require further treatment. In many cases, I perform additional treatment to prevent recurrence.  

 

Left before, right after surgery

This is a simulation, actual results may vary.

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Advantages of Private Epiretinal Membrane Surgery

“Your surgeon is the biggest factor in the outcome of your treatment”

  • I am an experienced full-time NHS Consultant who specialises in complex vitreoretinal and cataract surgery.

  • I have performed approximately 3000 vitreoretinal procedures, and personally perform and supervise approximately 300 retinal operations a year, including routine and complex retinal detachments.

  • My success rate for primary retinal detachments is above national averages.

  • I am one of the most highly–trained Vitreoretinal Surgeons in the Midlands, having completed 2 years of subspecialist high-volume vitreoretinal training fellowships at Moorfields Eye Hospital in London, one of the World’s Top Eye Hospitals. I am the Director of Vitreoretinal Surgery in my current NHS Hospital.

  • I will personally perform your initial and post-operative assessments, and will provide you with all the time you require in order to answer your questions and alleviate any fears and anxieties.

  • I will personally perform your surgery, rather than a trainee surgeon which is not uncommon in non-private settings (in particular in Teaching Hospitals).

  • You will have direct access to me from the outset, thereby circumventing some of the more traditional route requiring you to be seen by an optician and general ophthalmologist prior to being reviewed by a vitreoretinal surgeon.

  • As a private patient you may bypass any local NHS waiting lists for urgent surgery, resulting in accelerated curative treatment. This is particularly important if you have very recently developed a macular-off retinal detachment where surgery could still restore good central vision, but only if performed promptly. Such cases usually receive lower priority compared with macular-on retinal detachments in busy vitreoretinal departments.

  • At all stages of your treatment pathway, you will receive my direct access telephone number. This will negate the need to go via any third party, such as a secretary or the hospital, in order to obtain any routine or urgent advice. I will be available 7 days a week for you in this regard. This is a very important aspect to the service I pride myself in providing, giving you the reassurance and confidence to make your journey through this difficult time as smooth and anxiety-free as possible. 

  • This and all other aspects of the service I provide have resulted in very high satisfaction levels from my former patients, rating my service an average of 4.9/ 5 on Trustpilot.

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