Epiretinal Membranes: Causes, Symptoms, and Treatment
What Is an Epiretinal Membrane?
An epiretinal membrane is a thin layer of cells that grows on the inner surface of the retina, the light-sensitive tissue at the back of the eye. Understanding how it forms and what triggers it helps set the stage for everything else about this condition.
Certain cells, mainly glial cells, migrate through tiny openings in the retinal surface and begin to multiply. Over time, these cells spread into a sheet-like layer that can look like a piece of cellophane covering the macula, the central part of the retina responsible for sharp, detailed vision. This is why the condition is sometimes called cellophane maculopathy.
Most epiretinal membranes develop slowly. Some remain thin and cause little or no change to vision. Others thicken and contract over time, pulling on the retina beneath them and causing it to wrinkle or pucker. This wrinkling is why the condition is also called a macular pucker.
The most common trigger is a posterior vitreous detachment, or PVD. The vitreous is a clear, gel-like substance that fills the inside of the eye. As people age, the vitreous naturally shrinks and eventually pulls away from the retinal surface. When it does, it can leave behind tiny defects that allow cells to migrate and begin forming a membrane.
When no other underlying cause is found besides PVD, the condition is called an idiopathic epiretinal membrane. This accounts for the large majority of cases.
Some epiretinal membranes develop in response to another eye condition or event. These are called secondary epiretinal membranes and are less common than the idiopathic type.
Conditions that can lead to secondary epiretinal membranes include:
- Retinal tears or retinal detachment
- Diabetic retinopathy and other retinal vascular diseases
- Retinal vein occlusion
- Uveitis (inflammation inside the eye)
- Previous eye surgery, including cataract surgery
- Eye trauma or injury
Who Is at Risk?
Epiretinal membranes are among the more common retinal conditions in aging populations. Knowing the risk factors can help guide monitoring and support early detection.
Epiretinal membranes become more common as people age. Prevalence rises significantly in adults over 70, making age the single strongest risk factor. The condition affects people across many ethnic backgrounds, though prevalence rates can vary between populations.
Several factors increase the likelihood of developing an epiretinal membrane. Your provider can help you understand which of these may apply to your situation.
- Age over 50
- Posterior vitreous detachment
- History of retinal tears, detachment, or retinal surgery
- Diabetic retinopathy or retinal vein occlusion
- Uveitis or other inflammatory eye conditions
- Previous cataract surgery or other procedures inside the eye
Research has identified additional factors that may be linked to epiretinal membrane development. These include higher body mass index, smoking, elevated blood sugar, and high cholesterol. Longer axial length of the eye, which is associated with nearsightedness, has also been linked to higher prevalence in some studies.
Having an epiretinal membrane in one eye increases the chance of eventually developing one in the other eye, though this does not happen in every case.
Signs and Symptoms
Many epiretinal membranes cause no noticeable symptoms, especially early on. When symptoms do appear, they tend to develop gradually over weeks or months.
The most common symptom is metamorphopsia, a condition in which straight lines appear wavy, bent, or distorted. This happens because the membrane is wrinkling the retinal surface beneath it. Other symptoms include blurred central vision, difficulty reading or seeing fine detail, and a gray or cloudy patch in the center of vision.
Some people notice that objects appear slightly smaller through the affected eye, a phenomenon called micropsia. In some cases, a person may experience double vision in one eye, known as monocular diplopia.
Because epiretinal membranes typically affect only one eye, the unaffected eye often compensates. Many people do not realize anything is wrong until they happen to cover their better eye. Checking each eye separately on a regular basis can help reveal early changes.
An Amsler grid is a simple tool that can help you monitor for distortion at home. It consists of a pattern of evenly spaced straight lines with a dot in the center. Hold it at reading distance, cover one eye, and look directly at the center dot. If any lines appear wavy, bent, or missing, that may indicate a macular problem.
Check each eye separately at least once a week. If you notice new waviness, missing areas, or worsening distortion, contact your retinal specialist promptly for an evaluation.
Not all epiretinal membranes progress. Some remain stable for years without causing meaningful visual problems. However, when the membrane continues to thicken and contract, symptoms may gradually worsen. Activities that require sharp central vision, such as reading, driving, and recognizing faces, may become more difficult over time.
Diagnosis and Testing
A thorough evaluation is the foundation for managing an epiretinal membrane well. Several tools are used together to get a complete picture of your retinal health.
A retinal specialist can often detect an epiretinal membrane during a comprehensive dilated eye exam. After dilating the pupils with special drops, the specialist uses a bright light and magnifying lenses to examine the retinal surface. A thin, glistening membrane on the macula may be visible, and wrinkling of the retinal surface can sometimes be seen directly.
During the examination, your specialist will also look for any underlying conditions, such as retinal tears, signs of diabetic eye disease, or inflammation that could be contributing to the problem.
Optical coherence tomography, commonly called OCT, is the most important imaging tool for diagnosing and monitoring epiretinal membranes. OCT uses light waves to produce detailed cross-sectional images of the retinal layers. These images allow your retinal specialist to see the membrane, measure retinal thickness, and assess the degree of macular distortion.
OCT also reveals the health of specific retinal layers beneath the membrane. The condition of the ellipsoid zone, a key retinal layer visible on OCT, helps predict how well vision may recover after treatment. Central retinal thickness and the organization of the inner retinal layers are additional details that guide decision-making.
OCT-based staging systems help classify how mild or advanced an epiretinal membrane is. These systems help your specialist determine whether a membrane is stable or progressing toward a point where surgery may be beneficial.
For mild membranes with good vision, regular monitoring with OCT scans and visual acuity testing is the standard approach. Follow-up visits are typically scheduled every several months to track any changes over time.
Treatment Options
Treatment decisions depend on the severity of the membrane, the degree of visual change, and how much the condition is affecting daily life. Not every epiretinal membrane requires surgery.
When the membrane is thin, vision remains good, and symptoms are minimal, observation is the recommended approach. There are no eye drops, medications, or supplements that can dissolve or shrink an epiretinal membrane.
During observation, your retinal specialist will monitor your vision and retinal scans at regular intervals. If the membrane stays stable and vision remains adequate for daily activities, surgery may not be needed at all.
When an epiretinal membrane causes significant vision loss or bothersome distortion, the recommended treatment is a surgical procedure called pars plana vitrectomy with membrane peeling. During this procedure, small incisions are made in the wall of the eye, the vitreous gel is removed, and the membrane is carefully peeled from the retinal surface.
Surgery is typically considered when visual acuity drops below a certain level or when distortion significantly interferes with daily tasks. A meaningful proportion of patients experience vision improvement of two or more lines on an eye chart after vitrectomy, and overall success rates are well established in the medical literature.
During vitrectomy, many retinal specialists also remove a thin layer called the internal limiting membrane, or ILM. The ILM is the innermost layer of the retina and can serve as a scaffold that supports new membrane growth. Removing it during surgery reduces the risk of the epiretinal membrane coming back.
Special dyes are sometimes used during surgery to stain the membrane and the ILM, making them easier to identify and remove while protecting the underlying retinal tissue.
Vitrectomy can speed up cataract formation in patients who have not yet had cataract surgery. For these patients, many retinal specialists offer a combined procedure called phaco-vitrectomy, which addresses both the epiretinal membrane and the cataract in a single operation.
Whether to combine the procedures depends on the current condition of the lens, the patient's age, and overall eye health. Your retinal specialist will discuss the approach that makes the most sense for your individual situation.
What to Expect With Surgery
Understanding what happens before, during, and after surgery helps set realistic expectations and supports a smoother recovery.
Before scheduling surgery, your retinal specialist will perform a thorough evaluation that includes OCT imaging, visual acuity testing, and a complete retinal examination. These tests help determine whether surgery is likely to improve your vision and what level of improvement can reasonably be expected.
Research indicates that patients who undergo surgery earlier, while vision is still relatively good, tend to have more favorable long-term outcomes. Your specialist will discuss the right timing for your situation.
Vitrectomy for epiretinal membrane is typically performed as an outpatient procedure under local anesthesia. The surgery generally takes 30 to 60 minutes. After the vitreous gel is removed and the membrane is peeled, the eye is filled with a balanced salt solution that your eye naturally replaces with its own fluid over time.
After surgery, you will typically use antibiotic and anti-inflammatory eye drops for several weeks. Vision improvement is gradual, often occurring over weeks to months as the retina heals. Full visual recovery can take three to six months or longer depending on the individual.
While vitrectomy is effective, it is important to have realistic expectations going in. Vision improvement depends on how long the membrane was present, the degree of retinal distortion before surgery, and the health of the underlying retinal layers.
Distortion often improves after surgery but may not fully resolve in every case. The longer a membrane has been causing distortion, the less likely the retina is to return completely to its normal shape. This is one reason why timely monitoring matters and why appropriately timed surgery can make a meaningful difference.
Living With an Epiretinal Membrane
For patients who are managing a mild membrane without surgery, a few practical adjustments can make daily life more comfortable while you and your specialist monitor the situation.
Using brighter lighting for reading and close work can improve comfort when central vision is mildly affected. Magnifying devices and large-print materials may also be helpful for everyday tasks.
Because epiretinal membranes typically affect one eye, many people continue to function well using their unaffected eye. Tasks that depend on depth perception or fine central vision in both eyes may be somewhat more challenging, and it can help to be aware of this when driving or doing detailed work.
Many mild membranes remain stable indefinitely and cause little visual impairment over a person's lifetime. For those who do undergo surgery, the majority experience meaningful improvement in both visual acuity and distortion.
Advances in imaging and technology continue to improve how retinal specialists plan treatment and predict outcomes. Your specialist will use the latest available tools to guide your care at every stage.
Frequently Asked Questions
Here are answers to some of the questions patients most often ask about epiretinal membranes, with practical guidance to help you make informed decisions.
In very rare cases, an epiretinal membrane may partially separate from the retinal surface on its own, but this is uncommon. Most membranes remain in place once they form and do not dissolve or disappear with time. No eye drops or supplements can remove the membrane. The best approach is regular monitoring with your retinal specialist so that any meaningful change is caught early.
Vitrectomy with membrane peeling is a well-established procedure with a strong safety record when performed by an experienced retinal specialist. As with any surgical procedure, risks exist, including infection, bleeding, retinal tear or detachment, and acceleration of cataract formation. Serious complications are uncommon, and most patients tolerate the procedure well. Your specialist will review all risks with you in detail before any decision is made.
Vision improvement after epiretinal membrane surgery is gradual rather than immediate. Many patients begin to notice improvement within the first few weeks, but full recovery can take three to six months or occasionally longer. The speed and extent of recovery depend on how long the membrane was present, how much retinal distortion occurred before surgery, and the health of the retinal layers beneath the membrane. Patience during recovery is important.
Recurrence is possible but relatively uncommon, especially when the internal limiting membrane is also removed during surgery. Removing the ILM eliminates the surface on which new membrane growth can occur, significantly reducing the risk of the problem returning. Your retinal specialist will continue to monitor your eye after surgery to watch for any signs of recurrence and ensure your vision stays on track.
Having an epiretinal membrane in one eye is a recognized risk factor for developing one in the other eye, but it does not mean this will definitely happen. Many people live with an epiretinal membrane in only one eye throughout their lifetime. Regular eye exams that include OCT imaging are the best way to detect any early changes in the other eye so that your care team can respond promptly if needed.
If your vision has declined to the point where it affects your ability to read, drive, work, or complete everyday tasks comfortably, it is a good time to have a direct conversation with your retinal specialist about surgical options. A drop in visual acuity below a standard threshold or a meaningful increase in distortion are common factors that prompt that discussion. Your specialist will weigh your OCT findings, the rate of change in your vision, your daily visual needs, and your overall eye health before making any recommendation.
See Us for Expert Epiretinal Membrane Care
Our team at EyeCare Consultants of NJ is experienced in diagnosing and managing epiretinal membranes at every stage, from initial detection and careful monitoring through surgical treatment and recovery. We use advanced imaging technology to give you a precise, personalized picture of your retinal health and to guide every decision along the way. With two convenient locations serving patients across New Jersey, expert retinal care is close to home. We would be glad to see you and help protect the vision that matters most to you.
Highly recommend Dr. Kayserman. Extremely competent, experienced, highly personable
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Dr. Arnett deserves 10 stars. He is the best.
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Dr. Arnett has provided excellent medical attention for my retina eye surgery and has a very professional and positive bedside manner. I would highly recommend him.
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Dr. Larisa Kayzerman is a wonderful doctor. She is very attentive. Doctor maid operation the same day. I'm very satisfied with the result.
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