Epiretinal Membrane

Epiretinal Membrane (Macular Pucker)

As retina specialists, we commonly manage epiretinal membrane (ERM), also known as macular pucker. This condition involves the formation of a thin, translucent fibrous membrane on the surface of the macula—the central part of the retina responsible for sharp, detailed vision. ERM causes the macula to wrinkle or pucker, leading to distorted and blurred central vision.

ERM is most common in people over 50 and is often idiopathic (related to natural aging and posterior vitreous detachment). It can also occur after eye surgery, trauma, inflammation, retinal vein occlusion, or diabetic retinopathy. While many cases are mild and stable, significant visual distortion or progressive loss warrants evaluation and, when appropriate, surgical intervention.

What Is an Epiretinal Membrane?

The membrane forms as glial cells and fibroblasts proliferate on the inner retinal surface, contracting over time and pulling on the macula. This creates surface wrinkling, retinal striae, and sometimes a pseudohole appearance.

Here are characteristic fundus photographs of epiretinal membrane:

• Mild to moderate ERM showing subtle retinal striae and macular distortion:

• More advanced macular pucker with obvious wrinkling and vascular tortuosity:

• Severe ERM with pseudohole and significant puckering:

Symptoms of Epiretinal Membrane

Patients often report:

• Blurred or decreased central vision

• Metamorphopsia (distorted vision—straight lines appear wavy or bent)

• Difficulty reading, driving, or recognizing faces

• Double vision or ghosting of images

Patient-view illustrations demonstrating metamorphopsia caused by ERM:

• Amsler grid showing wavy, distorted lines typical of macular pucker:

• Another example of perceived visual distortion from ERM:

What to Expect During Your Epiretinal Membrane Evaluation

We perform a comprehensive assessment, including:

• Dilated fundus examination to visualize the membrane

• High-resolution optical coherence tomography (OCT)—the gold standard for diagnosing and staging ERM

Treatment Options

• Mild ERM with minimal symptoms: Observation and regular monitoring

• Significant visual distortion or progressive vision loss: Vitrectomy surgery with membrane peeling

During surgery, we gently remove the vitreous gel and carefully peel the epiretinal membrane from the macula surface. This is typically an outpatient procedure performed under local anesthesia.

When to Seek Care

If you notice new or worsening blurred vision, distorted lines, or difficulty with daily tasks, schedule an evaluation with a retina specialist promptly. Early intervention can prevent further vision loss and improve quality of life.

​​​​​​​Contact our team today for a comprehensive macular assessment and personalized treatment plan.