The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Epiretinal membrane (ERM) is a common condition involving the formation of fibrocellular material on the inner surface of the retina. The majority occur in the absence of associated ocular conditions and are termed idiopathic ERM, which makes up over 90% of cases. Most cases of idiopathic ERM are asymptomatic, but may cause blurred or distorted vision if the membrane contracts or crumples at the macula as it progresses. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and staging idiopathic ERM. It provides recommendations for documentation, monitoring and when referral is appropriate.
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What is an epiretinal membrane?
An epiretinal membrane is a condition where a very thin layer of scar tissue forms on the surface of the retina in an area called the macula, where the vision is sharpest. Clinically significant epiretinal membranes are quite common, affecting around 7% of people in later life. In many cases, an epiretinal membrane is discovered by chance at a routine eye examination and vision may not be affected. However, the membrane can sometimes contract and crumple the macula, resulting in distorted and/or blurred vision. The optometrist may need to perform a special examination known as optical coherence tomography (OCT) to confirm the presence of an epiretinal membrane and to determine how best to manage the condition.
How is an epiretinal membrane managed?
In the absence of symptoms or loss of vision an epiretinal membrane can be monitored by the optometrist as many cases do not require further treatment. Where vision is affected, the optometrist will refer the patient to a retinal specialist who may recommend an operation to remove the membrane. The usual operation for an epiretinal membrane involves firstly removing the jelly-like substance that fills the centre of the eye (a procedure called a vitrectomy) and the membrane is then gently peeled away using fine forceps. Following membrane removal, the distortion in vision is usually significantly improved, but the vision may initially be more blurred and it can take a few months to improve.