Epiretinal Membranes (ERM)

An epiretinal membrane (ERM), sometimes called a “macular pucker” or “cellophane maculopathy,” is a thin layer of scar-like tissue that forms on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye, and the macula is the central part responsible for sharp vision needed for reading and recognizing faces.

As the membrane contracts or wrinkles, it can distort the retina and cause blurred or distorted central vision. ERMs are common, especially in adults over age 50, and may affect one or both eyes.

Many epiretinal membranes remain mild and stable, while others may gradually worsen and require surgery.

What Causes an Epiretinal Membrane?

Epiretinal membranes develop when cells grow on the surface of the retina and form a thin sheet of scar tissue.

The most common cause is natural age-related changes inside the eye. As the vitreous gel inside the eye separates from the retina with aging, microscopic changes can stimulate membrane formation.

Other possible causes include:

Retinal tears or detachments
Diabetic retinopathy
Retinal vein occlusions
Eye inflammation (uveitis)
Previous eye surgery
Eye trauma

In many patients, no specific cause is identified.

Symptoms of Epiretinal Membranes

Some epiretinal membranes cause no symptoms and are discovered during a routine eye exam.

When symptoms occur, they may include:

Blurred central vision
Distorted or wavy vision
Difficulty reading small print
Objects appearing crooked or uneven
Double vision in one eye
Difficulty recognizing faces

Symptoms usually develop gradually over time.

Peripheral (side) vision is generally unaffected.

How Is an Epiretinal Membrane Diagnosed?

A retinal specialist can diagnose an ERM during a dilated eye examination.

Several imaging tests help evaluate the severity of the membrane and its effect on the retina.

Optical Coherence Tomography (OCT)

OCT is the most important test for ERMs. It creates detailed cross-sectional images of the retina and shows:

The membrane on the retinal surface
Retinal wrinkling
Macular swelling
Retinal thickening

OCT also helps monitor progression over time.

Fundus Photography

Retinal photographs document the appearance of the membrane and retinal distortion.

Amsler Grid

Patients may use an Amsler grid to monitor for increasing distortion or visual changes.

Do All Epiretinal Membranes Need Treatment?

No. Many epiretinal membranes are mild and do not significantly affect vision.

Observation may be recommended if:

Vision remains good
Symptoms are mild
The membrane is stable

Regular follow-up visits allow the retina specialist to monitor for progression.

When Is Surgery Recommended?

Surgery may be considered if:

Vision becomes significantly blurred
Distortion interferes with daily activities
Reading becomes difficult
Symptoms continue to worsen

The decision for surgery depends on the patient’s symptoms, visual needs, and retinal findings.

Vitrectomy Surgery for ERM

The standard treatment for a visually significant ERM is a procedure called pars plana vitrectomy with membrane peel.

During surgery:

The vitreous gel is removed
The epiretinal membrane is carefully peeled from the retinal surface
Sometimes an additional internal retinal layer is peeled to reduce recurrence risk

The procedure is usually performed under local anesthesia with sedation.

Recovery After Surgery

Vision often improves gradually over weeks to months after surgery.

Many patients notice:

Reduced distortion
Improved reading ability
Better visual clarity

However, vision may not fully return to normal, especially if the membrane was severe or long-standing.

What Is the Prognosis?

The outlook for epiretinal membranes is generally very good.

Many patients:

Maintain stable vision without surgery
Experience successful improvement after surgery
Recover useful reading and driving vision

The degree of improvement depends on:

How long the membrane has been present
The amount of retinal distortion
Overall retinal health

Some mild distortion or blurry vision may persist even after surgery.

Living With an Epiretinal Membrane

Patients with ERMs should:

Keep regular retina appointments
Monitor vision changes
Report increasing distortion promptly
Use good lighting for reading
Consider magnification tools if needed

Most patients continue normal daily activities successfully.

Frequently Asked Questions

Is an epiretinal membrane the same as macular degeneration?

No. ERMs and macular degeneration are different conditions. However, both can affect the macula and cause blurry central vision.

Can an epiretinal membrane go away on its own?

Most ERMs do not disappear completely on their own, although some remain stable for years without causing major problems.

Is surgery always necessary?

No. Many patients never require surgery. Surgery is usually recommended only when vision problems become bothersome or interfere with daily activities.

More Information

For additional patient information, visit the American Society of Retina Specialists Epiretinal Membranes Page