Epiretinal Membrane (Macular Pucker)

An epiretinal membrane (ERM) is layer of wrinkled, bumpy tissue that forms on the retina in your eye. Eye doctors also call it macular pucker or scar tissue.

An epiretinal membrane can affect your vision by causing distortion in what you see through that eye.

The retina is at the back of your eye. It contains special nerve cells that react to light. The macula is a small part of your retina that’s responsible for what you see right in front of you. This is called your central vision.

ERMs usually form in only one of your eyes. But they can happen in both of your eyes at the same time. This is less common.

Visit an eye doctor if you notice any changes in your vision, especially if they happen suddenly.

Epiretinal membrane symptoms

Seeing distorted, wavy lines in the center of your vision is the most common symptom of an epiretinal membrane. Eye doctors call this metamorphopsia. It’ll be most noticeable when you’re looking at something with straight lines. Words on a screen or symbols on road signs might look slightly off. It might feel like you’re looking through plastic wrap or cellophane.

The distortion in your vision may get worse over time. At first, small details will look wavy or out of focus. If the ERM gets worse, it may start to affect your vision more noticeably. More severe epiretinal membranes can cause double vision and blurry vision. Wearing your glasses or contacts won’t fix these issues.

Some people don’t notice vision changes from an ERM. Our brains are sometimes too good at adjusting to obstacles, and you might “get used” to having distorted vision. If this happens to you, your eye doctor will still be able to see and diagnose an epiretinal membrane.

ERM causes

Most epiretinal membranes happen without a known cause. Healthcare providers call this idiopathic. They usually develop naturally as you age.

Your eyes are full of a gel called vitreous humor. Usually, the vitreous humor is pressed flat up against your retina. As you get older, the gel naturally thins out and becomes more like a liquid. As the gel liquifies, it might not press against your retina like it should. This can cause scar tissue to form on the surface of your retina. It causes the puckering that affects your vision.

Anything that damages your retina can also cause scar tissue to form on it, including:

• Retina tears
• Detached retinas
• Complications from eye surgery
• Eye injuries
• Infections
• Diabetes-related retinopathy
• Eye inflammation

These causes are less common. Macular pucker usually happens without an exact cause.

Risk factors

Your risk increases as you age. Epiretinal membranes are most common in people over 50. Experts estimate that around 2 in 10 people over 75 have an ERM.

You might have a higher risk of epiretinal membranes if you have diabetes or any of the conditions that can cause it. Having eye surgery or experiencing any of the injuries listed above can increase your risk, too.

Complications of ERMs

Untreated epiretinal membranes can sometimes cause complications in your eyes and vision, including:

• Blurry vision
• Double vision
• An image appearing larger in one eye than the other
• Detached or torn retinas
• Macular holes

How doctors diagnose macular pucker

An eye doctor can diagnose an epiretinal membrane with a routine eye exam. Your eye doctor will dilate your eyes and look inside them to see your retinas.

Tell your eye doctor when you first noticed changes in your vision. Let them know how quickly symptoms started or changed.

You might need a few other tests, including:

• An Amsler grid eye test: This checks for distorted vision. You’ll look at a page of small squares formed by horizontal and vertical lines and tell your eye doctor if any lines look wavy or distorted.
• Optical coherence tomography: This is an imaging method that takes pictures of your retina.

Epiretinal membrane treatments

You may not need any treatment for an ERM. It depends on how much it affects your vision and its cause. Your eye doctor will monitor it to make sure it doesn’t change too much or increase your risk of complications.

If you do need treatment, options can include:

• New glasses or contacts: These can’t correct the epiretinal membrane. But they can help you see more clearly or compensate for changes in your eyes.
• Vision aids: Your eye doctor might suggest using magnifying devices to help you see more clearly. You may need to get more lamps or a reading light to help you focus on screens or printed words.
• Surgery: Your eye doctor will suggest surgery if you have a high risk of complications. An eye surgeon will remove the membrane or scar tissue from your retina with a vitrectomy.

You might need treatments for the cause if a health condition or injury leads to an ERM. Your eye doctor will tell you what to expect.

When should I see my healthcare provider?

Visit an eye doctor if you notice any changes in your eyes or vision. See your eye doctor for regular eye exams as often as they suggest.

Go to the emergency room or call 911 (or your local emergency services number) if you suddenly lose your vision or have severe eye pain.

What can I expect if I have macular pucker?

Most ERMs don’t need treatment. You’ll need regular eye exams. Your eye doctor will monitor your eyes for any changes. This is the best way to catch warning signs of complications.

An epiretinal membrane might change your vision. But it’s rare for it to cause blindness. You may have to adjust to the wavy appearance in your central vision. Your eye doctor can help you get used to any changes in your sight.