What are Epiretinal Membranes and Macular Holes?

An epiretinal membrane is a thin scar-like tissue that grows over the retina. The retina is the lining at the back of the eye that is responsible for vision. The scar-like tissue grows directly over the macula, which is the tiny portion of the retina that is responsible for sharp, central vision. When the macular tissue is distorted by the membrane, a hole can form that could become bigger over time and progressively reduce vision.

What causes Epiretinal Membranes and Macular Holes?

As we age, the vitreous, or jelly-like substance inside the eye changes and starts to shrink. This shrinking causes the vitreous to pull away from the retina and scar-like tissue may develop. As the scar-like tissue contracts, it causes the retina to wrinkle or pucker. Other causes of epiretinal membranes include trauma, an eye injury, retinal tear or detachment, inflammation, and problems with the retinal blood vessels. If the vitreous is firmly attached to the retina when it pulls away and the macular tissue stretches to the point that it tears, a hole can result. Less common causes of macular holes are injury and long-term swelling of the macula.

What are the Symptoms?

How an epiretinal membrane can distort your vision

With an epiretinal membrane, patients may notice that their vision is blurry and/or distorted. Straight lines can appear wavy.

In the case of a macular hole, the size of the hole determines how much it will reduce vision. Larger holes cause greater vision loss. Vision often is reduced to 20/200 or less if the hole is not repaired.

It is important to note that if the macula is damaged, you will not lose all of your vision. You still will have peripheral, or side, vision.

How are Epiretinal Veins and Macular Holes Detected?

Your eye doctor will use eye drops to dilate, or enlarge your pupils. Dilating the pupils allows your eye doctor to view the back of the eye better. If epiretinal membranes or macular holes are suspected, you may need testing, including a fluorescein angiography. Fluorescein angiography is a diagnostic test that uses a drug called fluorescein that is injected into a vein in your arm to enhance the specialized photograph that is taken to evaluate the retina.

What are the Treatment Options?

Treatment of an epiretinal membrane is not always necessary. If the symptoms are mild then observation may be all that is needed. However, when treatment is required, surgery is the only effective option for both epiretinal membrane and macular holes. Your retina doctor may recommend an operation called a “vitrectomy.” A vitrectomy is an outpatient surgical procedure done in an operating room.

• Epiretinal Membranes – The scar tissue and vitreous are removed and replaced with a clear solution. Most patients recover about half of their lost vision and distortion usually is reduced significantly.
• Macular Holes – The vitreous is removed and replaced with a gas bubble that eventually fills with natural fluids. Scar tissue around the hole is removed. Following surgery, patients usually must keep their faces down for a few days. This position allows the bubble to press against the macula and seal the hole. Most patients have a significant improvement in vision.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment, either during surgery or afterward.

What You Can Do to Protect Your Vision

Early detection and treatment, is the best way to prevent vision loss. Regular yearly examinations by your eye doctor are extremely important because eye problems can develop at any age.

Making the Most of Your Remaining Vision

Losing some vision doesn’t have to rob you of life’s simplest pleasures if you learn how to use your remaining eyesight to see your best. Low vision aids, special lenses, or electronic systems and training can maximize your ability to read and perform other activities. The Low Vision Rehabilitation Center of Retina Consultants of Southwest Florida can give you more information about the training and devices available.