What is Macular Pucker / Epiretinal Membrane (ERM)?

Macular Pucker and Epiretinal Membrane (ERM) are terms used interchangeably to describe a condition in which a thin layer of scar tissue forms on the macula—the central part of the retina responsible for detailed vision. This scar tissue can contract or wrinkle, causing distortion of the retina and impacting central vision.

Symptoms

The symptoms of ERM can vary widely, ranging from mild to severe. These symptoms often progress gradually, though the pace and severity can vary depending on the individual.

  • Distorted vision: Straight lines may appear wavy or bent.
  • Blurred central vision: A decrease in the clarity of fine details.
  • Difficulty reading or recognizing faces: A common challenge due to central vision distortion.
  • Double vision in one eye: In some cases, ERM can cause monocular double vision.
  • Gray or cloudy spots in central vision: This can obscure the details of objects directly in front of you.

Causes

ERM typically develops as part of the natural aging process. Over time, the vitreous gel inside the eye shrinks and pulls away from the retina, a phenomenon known as posterior vitreous detachment (PVD). During this process, small amounts of microscopic cells may remain on the macula, leading to scar tissue formation. This scar tissue can contract, creating the characteristic wrinkling or puckering seen in ERM. While aging is the most common cause, other factors can contribute to ERM development, including:

  • Retinal tears or detachment
  • Eye trauma or surgery
  • Inflammatory eye conditions, such as uveitis
  • Diabetic retinopathy

Risk Factors

  • Age: The risk increases significantly after age 50.
  • Previous eye conditions: Such as retinal detachment or uveitis.
  • Diabetes: Diabetic retinopathy is a known risk factor.
  • Eye trauma or surgery: Including cataract surgery or laser treatments.
  • Genetics: A family history of retinal disorders can elevate the risk.

Treatment Options

The treatment approach for ERM depends on the severity of symptoms and the impact on daily activities. While mild cases may not require intervention, more severe cases may necessitate surgical treatment.

Non-surgical management:  In cases where symptoms are mild and vision is relatively unaffected, regular monitoring and observation may be sufficient. Additionally, updated prescription glasses may help optimize vision for individuals with mild distortion. Please note that RAWNY does not have an optical shop.

Surgical Intervention: For individuals with significant vision impairment, vitrectomy surgery is often recommended. This procedure involves the removal of the vitreous gel and the peeling of the epiretinal membrane from the macula. Your physician will discuss which treatments would be most beneficial for your condition. Learn more about how macular pucker/ERM surgeries are performed on our Treatments & Surgery page.

If you experience any symptoms of macular pucker/ERM, contact Retina Associates of Western NY for a prompt evaluation and treatment.