Optometry case study: Epiretinal membrane

953

by Peter McNulty, Specsavers Ballarat, Australia

History

78 year old, female.
Px presented for a routine check. Wears reading glasses only, no correction for distance.
Complains of eyes being ‘a bit watery and sore from time to time’.
Uses Refresh drops which help.
GH: u/a thyroid and hyperlipidaemia
Meds: for above, unsure of names.
POH: Bilateral phacoemulsification + IOLs.
FOH: none

Examination
RE: plano / -0.75 x 103 VA 6/7.5 Add 2.50 N5
LE: plano / -1.00 x 95 VA 6/ 7.5 Add 2.50 N5
External eye – normal
IOPs RE 14mm Hg
LE 14 mm Hg at 2.00 pm.

Digital retinal photography
RE only shown, LE normal.

 

 

 

 

Close up of right macula

 

 

 

 

Amsler – no defect R+L but RE ‘not as clear’

Diagnosis

Provisional diagnosis
Vitreous traction on the macula from an epiretinal membrane.

Management
Referred to Hospital Eye Service where the provisional diagnosis was confirmed. The ophthalmologist decided to monitor this patient. Six month review.

Discussion
An epiretinal membrane is a collection of cells that occurs on the inner surface of the central retina. These membranes can contract causing reduced vision and distortion as they pull on the underlying retina. They are quite common, occurring in about 7% of the population, roughly 10% are bilateral.

They can be idiopathic (no known cause) or secondary to retinal detachment surgery, retinal tears, pan retinal photocoagulation or trauma. The secondary types are more severe than the primary types.

Management, as in this case, is often by observation if the membrane is mild and non progressive. If the membrane spontaneously separates from the retina then symptoms can
resolve. Surgical removal of the membrane by vitrectomy can improve both the patient’s distortion and visual acuity.

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