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My Eyeballs Can Get Wrinkles, Too?


A wrinkle on the retina -- which is also known as an epiretinal membrane (ERM) or a macular pucker -- is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina's surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma, or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

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What can be expected during a contact lens fitting?

A patient can expect to have a different experience when having a contact lens fitting. In addition to the eyeglass exam, questions will be asked to determine which contact lens will work best for them. Will they want to leave the lenses in their eyes overnight or will they remove them every day? Will they wear them only occasionally or will they be for everyday use? Do they want a contact lens that they throw away every day or do they want a contact lens that they have to clean and disinfect? If the patient is over age 40 and has a compromised ability to see up close, how will they see up close with their contact lenses? Will they wear readers over their distant contacts, or will they wear multifocal contacts, or will they wear monovision?

Are some people more prone to having Dry Eyes than others?

Experiencing dry eye symptoms is more common as we grow older, particularly in people 50 years of age and older. Hormonal changes in women who are experiencing menopause or who are post-menopausal. Inflammation in our body can affect the tear gland's ability to produce tears. Eye or health conditions such as glaucoma, diabetes, lupus, rheumatoid arthritis, and Sjogren's Syndrome can be associated with Dry Eyes. Environmental conditions such as dry winter air, dry indoor heated air, working on the computer, and wearing contact lenses can cause Dry Eyes.

Are there advantages to single-use contact lenses? What are they?

Single-use daily wear contacts are convenient to the patient and a healthy recommendation from their eye doctor. At the end of the day, the patient only has to dispose of the contacts. There is no need to take the contacts out to clean and disinfect them. The patients time and money spent on solutions and caring for them are eliminated. Not to mention that the next time they wear a contact, they will be wearing a brand new contact! The single best recommendation your eye doctor can make is to recommend single-use daily wear contacts. They are the healthiest contact that can be worn. The contact lens pathology issues of wearing the same contact for two or four weeks such as neovascularization, microcystic edema, and bacterial infections are greatly reduced.

What is an eye infection?

Your eyes can get infections from bacteria, fungi, or viruses. Eye infections can occur in different parts of the eye and can affect just one eye or both. Two common eye infections are conjunctivitis (also known as pink eye) and lid styes which are swollen lid bumps that can also be painful. Common signs of an eye infection are pain, itching, or a sensation of a foreign body in the eye, photosensitivity, redness or small red lines in the white of the eye, discharge of yellow pus that may be crusty upon awaking, and tears.

What happens during a typical Diabetic Eye Exam?

Your Eye Doctor will evaluate the back of your eye called the Retina to check for leaking blood vessels. Diabetic retinopathy occurs when elevated blood sugars damage the walls of the blood vessels. The vessel walls may thicken, leak, develop clots, close off, or grow balloon-like defects called microaneurysms.

My eyes tear all the time. Why do you call it Dry Eyes?

Your eyes have extra tears because your eyes produce extra tears to combat irritation and dryness. A better way to describe Dry Eyes is tear film instability, which refers to the composition of your tears not being in the proper composition. Stopping eyes from producing extra tears is a goal in the treatment of Dry Eyes.

At what age should my child have his/her eyes examined?

If you ask 10 different Doctors you will get 10 different answers. Newborns have their eyes checked in the birthing ward for starters. From birth to age 5 their eyes are growing. At age 5 is a good time to schedule a regular eye examination, however, if any unusual eye behavior is observed under age 5 an eye exam should be scheduled at that time. Unusual eye behavior such as eye squinting, a head tilt, or having to get close to see.