What is an Epiretinal Membrane?
An Epiretinal Membrane occurs when a thin layer of cells grows over the retina, with time these cells contract and form scar-tissue. As the scar-tissue continues to contract, it can pull and distort the shape of the macula resulting in blurry and ‘wavy’ central vision. Epiretinal membranes will impair ‘straight-ahead’ activities, such as driving or reading.
Who is at risk of developing an Epiretinal Membrane?
Cases of Epiretinal Membrane typically occur in people over the age of 50, following a Posterior Vitreous Detachment. It is not understood why some people are more inclined than others, however, Epiretinal Membranes can also be connected to other eye conditions including diabetic eye disease, eye inflammation (uveitis), trauma and retinal detachment. Please note that Epiretinal Membranes do not represent or increase the risk of Age Related Macular Degeneration.
What are the symptoms of an Epiretinal Membrane?
Most people are unaware of having developed an Epiretinal Membrane and it is usually not discovered until during your regular eye checkup. Mild Epiretinal Membranes may not display obvious symptoms, however, more advanced cases can exhibit the following:
- Distorted vision (straight lines appear wavy)
- Increasing blur of printed words
- Difficulty reading
- Difficulty recognising faces
- Reduced intensity or brightness of colour
Epiretinal Membrane progression is highly erratic. The majority of mild Epiretinal Membranes will continue to stay stable or over time change slowly. However, patients with a history of recent and/or rapid Membrane growth are more likely to experience rapid membrane growth and diminished vision.
How are Epiretinal Membranes Detected?
Dilating eye drops are used to enlarge the pupil and then using a slit lamp microscope, the retina and macula are viewed in detail. These drops will blur your vision for 2-3 hours and it is highly recommended that you do not drive on the day of your eye exam.
Optical Coherence Tomography (OCT):
Optical coherence tomography (OCT) is a non-invasive imaging test which uses light waves to detect areas of macular thickening or thinning. This screening can confirm if an Epiretinal membrane is present and highlights the affected areas. OCT is also often used to monitor membrane development.
During this medical procedure, a fluorescein dye (vegetable based) is injected into a vein in the arm, the dye then travels through the circulatory system to the blood vessels in the eye. From here a series of photographs are taken as the dye passes through the blood vessels in the retina. Fluorescein angiography can be used to determine the extent of damage caused by an Epiretinal membrane, as well as detect and/or rule out other possible macular conditions.
What treatments are available for Epiretinal Membranes?
Currently, there are no eye drops, medications or laser treatments available that can stop the formation of Epiretinal membrane or prevent the development of an already formed one. Minor cases of Epiretinal membranes can cause mild blurriness and distortion and will require regular appointments with the Eye Specialist Institute and the use of an Amsler Grid to monitor the membrane.However, if your case of Epiretinal membrane progresses to cause significant vision loss, your retinal specialist may recommend performing a vitrectomy surgery to have the membrane removed.
Vitrectomy surgery is performed under local anaesthetic by a retinal specialist. Using surgical instruments a dye is injected into the eye cavity to identity the layer of scar tissue. Next, the Epiretinal membrane is carefully peeled away from the macula. The eye is then filled with an air bubble to seal the wound, maintain the structure of the eye and aid in recovery of the macula. After this surgical procedure, patients are required to lay with their head positioned in a certain way to ensure that the air bubble floats to the macula to form a support structure. The air will be absorbed by the eye over a time period of approximately 7-10 days and the eye will then produce Aqueous, a liquid to replace the air. As the eye absorbs the air, your vision will begin to return, however the full process of restoring vision can take place over 6-18 months in total.
Vitrectomy has proven to be greatly successfully in reducing or eliminating visual distortion and preventing further sight loss. Approximately 80% of patients find that their overall quality of vision improves, with 70-80% of people’s central eyesight increasing. 20% see no improvement in their vision following a Vitrectomy, however the procedure will have prevented further vision loss. The Eye Specialist Institute recommends seeking medical advice as soon as possible, the longer you prolong treatment for Epiretinal membrane the more chance you have of damaging your eyesight.
What can I expect after Epiretinal Membrane surgery?
Post vitrectomy surgery patients typically feel no pain, although it is normal to experience temporary mild to moderate redness and grittiness (in the eye?), as well as swelling and drooping of the eyelid. Vision is generally restricted in the first week or so, and by one months’ time most patients have regained their preoperative level of vision. In 6-18 months’ time patients experience complete vision improvement, with approximately half of the vision lost is regained. Some mild central distortion may remain after recovery time. It should also be noted that a Vitrectomy will accelerate the growth of any cataracts present and they will therefore require earlier surgical removal.
If your eye specialist inserted an air bubble into your retina/eye at the end of the vitrectomy you will not be able to fly for at least a week after the operation. As for physical activity you can resume light physical activity 24 hours after surgery, and moderate activity in 2 weeks’ time. You should hold off from any heavy physical activity for 6-8 weeks at least to ensure your eye has had time to heal. You may shower and bathe normally following surgery, however, please take extra care to avoid getting water into the eye during the first month after the vitrectomy. For more information about this procedure or if you have any questions regarding Epiretinal membrane, please contact us at the Eye Specialist Institute today.
Advancements in the treatment of Epiretinal membrane has resulted in a faster healing time, with minimal Post-operative discomfort for the patient. You will be required to wear an eye patch for at least 24 hours after surgery, followed by a dose of eye drops or ointment to aid the healing process.
Overall, patients are able to resume their daily routine quite quickly and non-strenuous activities can be taken up again within a day’s time. However, the time period to return to work, sports or drive again after surgery can vary from patient to patient. Each person is different so please do not feel rushed to finish the recovery period.
Treatment for cases of Epiretinal membrane are highly effective, but only if they are detected before the damage becomes too great. Although it is not a medical emergency it is still extremely important that you are diagnosed and organise treatment sooner rather than later. Your health and wellbeing is first priority to us at the Eye Specialist Institute, for more information on Epiretinal membranes or to book an appointment with one of our specialists please do not hesitate to contact us.