Diagnosing a Wrinkled Retina

Epiretinal membranes have several synonyms: cellophane membranes, surface wrinkling retinopathy, macular pucker, or simply, a wrinkle of the retina. The symptoms that you may experience with a wrinkled retina include blurry vision while reading or driving, distortion of lines that are supposed to be straight or decreased depth perception. Dr. Kirsch or Dr. Hairston can diagnose a wrinkled retina during a detailed, painless examination of the retina using special lenses and instruments. In some patients, the doctor will recommend a fluorescein angiogram test to determine whether the scar tissue is distorting the retinal blood vessels so much that fluid leaks from these vessels into the retina. This condition is then called macular edema and poses a more serious threat to vision than if no fluid is present. A noninvasive ocular computed tomogram (OCT) is also performed to measure the thickness of the retina and show the epiretinal membrane in minute detail.

What to know about a Wrinkled Retina

What will happen to your vision if you have a wrinkled retina? Fortunately, in most patients, vision is only mildly affected. However, in some cases, over a period of several months or years, the vision can gradually decrease to the level of legal blindness. A wrinkled retina will almost never cause total blindness. Wrinkled retinas can affect both eyes in about 1 out of 10 patients, although one eye is usually worse than the other and both eyes are not usually affected at the same time. The best way to monitor the health of your retina is to test your eyesight every week with the Amsler Grid that you were given. It is important to remember to look at the grid with one eye at a time, covering the other eye.

Treatment

The treatment Dr. Kirsch or Dr. Hairston recommend for wrinkled retinas is custom-designed for your individual situation. If the vision is still good enough for you to read and drive, and the symptoms of distortion are not bothering you very much, conservative observation with regular examinations every 4 to 6 months is usually recommended. It will be essential to monitor the amount of fluid in the retina usually through examinations or with the fluorescein dye test. However, if the symptoms are difficult for you to tolerate or the vision has significantly decreased, then surgery is usually offered as the treatment of choice. Surgery is not usually recommended until the vision drops to 20/40 or worse (3 lines below 20/20). Before discussing surgery, it is important to understand that there are no medications, eye drops, vitamins or laser treatments that can treat a wrinkled retina. Surgery is the only way to treat epiretinal membranes.

Surgery

The operation for a wrinkled retina is performed in the Surgery Center and is usually done under local anesthesia. You will go home the same day. The risks of this operation include: retinal detachment (occasionally), infection inside the eye (rarely) and bleeding inside the eye (rarely). These complications are treatable most of the time, although as with any surgery inside the eye, loss of eyesight can rarely result. In some patients (about 1%), the scar tissue grows back. If you already have a cataract, vitrectomy surgery will most likely make it worse.

The surgery is called a vitrectomy because the vitreous gel inside the eye is removed through 3 tiny incisions that do not require stitches. The vitreous gel is replaced with salt water. The vitreous is like your appendix; you have it but you are sometimes better off without it! The edge of the scar tissue is then identified and separated from the surface of the retina. Using special microscopic forceps, the scar tissue is peeled from the surface of the retina like you would peel a label from its backing.

Surgical Prognosis

The surgery for wrinkled retinas is successful in the vast majority of patients, although it can take from 6 to 12 months for the vision to improve. The vision and symptoms in eyes with wrinkled retinas can be improved in 80% to 90% of cases.

The level to which your vision will improve depends primarily upon the starting point of your vision. Usually, we say that the vision will improve halfway back to 20/20. Take the bottom number of your starting vision and divide it by two. In other words, if your vision is 20/50 before surgery, you can expect 20/25 as a result; if it is 20/80 before surgery, it will likely improve to 20/40. Working with Dr. Kirsch or Dr. Hairston, you can decide which course of action is best for your situation to best preserve or restore the precious gift of sight.