Scar tissue on your retina may sound scary, but it’s not. An epiretinal membrane is a thin layer of scar tissue that forms on the surface of your macula, the central part of your retina. It can blur and distort central vision over time. Another name for this same thing is Macular Pucker.
Many Oregonians with an epiretinal membrane notice that reading becomes harder, or that straight lines become wavy over time. The condition is common, often progresses slowly, and is treatable when symptoms become bothersome and affect vision. Here is what you need to know.
What Is an Epiretinal Membrane?
The retina is a thin layer of light-sensitive tissue that lines the back of your eye. At its center sits the macula, which handles sharp, detailed vision. Its the film in the camera of your eye. An epiretinal membrane — also called a macular pucker, cellophane maculopathy, or preretinal membrane — is a thin sheet of fibrous tissue that grows across the surface of the macula. Its just a couple of microns thick.
As the membrane forms and contracts, it can pull on the underlying retinal tissue, causing the macula to wrinkle or pucker. That wrinkling is what distorts vision, just like wrinkled film in your camera would yeild a wringled or distorted photo. The condition is not the same as a macular hole, though both involve the macula.
What Causes an Epiretinal Membrane?
Most epiretinal membranes are idiopathic, meaning they develop without a clear underlying cause. They are most common after age 50, as the vitreous — the gel filling the eye — naturally shrinks and separates from the retina. This separation, called posterior vitreous detachment (PVD) causes micro trauma to the surface of the retina and thus triggers a mild healing response that sometimes leads to scar tissue formation on the macular surface.
Other conditions that can cause or accelerate epiretinal membrane formation include retinal tears or detachment, inflammation inside the eye (uveitis), diabetic retinopathy, retinal vein occlusion, and previous eye surgery. In these cases, the membrane is considered secondary rather than idiopathic.
Epiretinal membranes affect an estimated 2 percent of people over 50 and up to 20 percent of people over 75. Across Oregon, particularly in older communities along the Oregon Coast and in the Willamette Valley, they are one of the more common conditions seen by our retina specialist at Retina Care.
Symptoms: What You Might Notice
Epiretinal membranes range from mild to significant in their effect on vision. Many cause no symptoms at all and are found incidentally during a routine eye exam. When symptoms do occur, they typically include blurred or distorted central vision, straight lines appearing wavy or bent (metamorphopsia), difficulty reading fine print, and a mild pixelated or blurry area at the center of vision.
Symptoms usually affect one eye. Double vision in a single eye — seeing a ghost image slightly offset from the main image — can also occur. If you notice any of these changes, it warrents evaluation by our retina specialist. Many patients in Eugene, Salem, and Roseburg first notice symptoms during everyday tasks like reading small print or observing the lines on roads when driving.
How Is an Epiretinal Membrane Diagnosed?
Diagnosis is straightforward. Your retina specialist will dilate your pupils and examine the back of your eye, then confirm the diagnosis with optical coherence tomography (OCT) — a non-invasive scan that produces high-resolution cross-section images of the retina. OCT shows exactly how thick the membrane is, how much retinal distortion is present, and whether the macula has swelled. This information guides treatment decisions and helps track changes over time.
Does an Epiretinal Membrane Always Need Treatment?
No. Many epiretinal membranes are mild and stable. If your vision is only very mildly affected and not interfering with daily life, we may recommend monitoring with periodic OCT scans rather than immediate treatment. Some membranes stay stable for years and don’t require treatment.
The decision to proceed with surgery depends on how much the membrane affects your quality of life — your ability to read, drive, work, and do the things that matter to you. There are no eye drops or medications that dissolve an epiretinal membrane. When it becomes visually significant, surgery is the only effective option.
Surgery: Vitrectomy with Membrane Peel
The treatment for an epiretinal membrane is a vitrectomy with membrane peel — an outpatient procedure performed under local anesthesia. With the modern minimally invasive methods that Dr. Peter Karth, MD, MBA, FASRS, FACS has pioneered, its very similar to cataract surgery from a patient perspective.
During the procedure, Dr. Peter Karth removes the vitreous gel and then carefully peels the membrane away from the retinal surface using fine surgical instruments under a microscope. In nearly all cases, Dr. Peter Karth also peels the internal limiting membrane (ILM), a thin layer just beneath the epiretinal membrane, to reduce the chance of recurrence and improve outcomes.
Recovery After Surgery
Recovery from an epiretinal membrane surgery performed with Dr. Peter Karth’s minimally invasive techniques is extremely easy from a recovery standpoint. There is no air or gas bubble and no face-down positioning requirement in nearly all cases. Vision will be blurry for a few days but be back to baseline (pre-operative vision) within the first few weeks. Dr. Peter Karth does not require positioning or restrictions after surgery.
Full visual improvement takes a full year, as the retina gradually flattens and stabilizes. Some distortion may persist even after successful surgery, particularly if the membrane was present for a long time before it was removed. The data says that up to 20% of patients get very little improvement despite having their membrane removed correctly with surgery.
How Much Vision Can You Expect to Recover?
Surgery successfully improves vision in the majority of patients — studies consistently show improvement in roughly 75 to 90 percent of cases. The degree of improvement depends on how long the membrane was present and how much distortion had developed in the retinal tissue. Patients who seek care earlier tend to achieve better visual outcomes than those who wait until distortion is severe.
It is important to have realistic expectations. Surgery usually improves vision meaningfully, but it rarely restores it to exactly what it was before the membrane formed.
Getting Care for an Epiretinal Membrane in Oregon
Retina Care serves patients across western and coastal Oregon, with clinic locations accessible to patients in Eugene, Salem, Roseburg, Coos Bay, Bandon, Coquille, and surrounding communities. Dr. Peter Karth, MD, MBA, FASRS, FACS focuses exclusively on retinal disease, which means every epiretinal membrane evaluation and surgery is performed by Dr. Peter Karth.
If straight lines look wavy, your reading vision has blurred, or a routine eye exam revealed an epiretinal membrane, do not put off a specialist evaluation. Early assessment gives you the most options.
At Retina Care, retinal specialist Peter Karth, MD, MBA, FASRS, FACS is happy to help you with your retina concerns. Please call 541-873-8462 to schedule an appointment at a location near you.