Idiopathic Epiretinal Membrane and Vitreomacular Traction

Publication Date: February 1, 2020

Recommendations

Diagnosis 

Optical Coherence Tomography 

Spectral domain OCT is a highly sensitive and routine method used to diagnose and characterize VMA, ERM, VMT, and the associated retinal changes.
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Discussion with Patient

Patients should be informed that the majority of ERMs will remain relatively stable and do not require therapy.
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Patients should also be reassured that there is a very successful surgical procedure that could address worsening symptoms or decreasing visual acuity.
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Furthermore, patients should be encouraged to periodically test their central vision monocularly in order to detect changes that may occur over time, such as increasing metamorphopsia and/or development of a small, central scotoma.
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Educating patients about the signs and symptoms of progression and regular monocular Amsler grid testing are both important. Although the visual acuity rarely improves spontaneously, it may worsen. If patients' symptoms worsen, a vitrectomy could be considered. Patients do not typically improve without vitrectomy surgery when the area of VMT is broad (>1500 μm), when there is an accompanying pathologic detachment of the macula, or when the presenting visual acuity is poor.
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Appropriate intervention should be made with careful informed consent and a discussion of the risk-benefit ratio of surgery.
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Treatment 

Vitreopharmacolysis – Ocriplasmin 

The treating physician should discuss the option of treating patients who have VMT with ocriplasmin and compare the treatment with observation, a gas bubble injected into the vitreous, or vitrectomy surgery.
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The discussion should include the relevant risks versus benefits for each of these options.
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Outcome 

Vitrectomy surgery is often indicated in patients who are affected with a decrease in visual acuity, metamorphopsia, double vision, or difficulty using their eyes together.
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Predictors Of Visual Results After Surgery 

The outer retina, the ellipsoid zone (EZ), and the photoreceptors' outer segment length may improve or even normalize after vitrectomy, and each feature is correlated with improved visual acuity.
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Follow-Up Evaluation After Surgery 

Patients who have surgery should be examined on postoperative day 1 and again 1–2 weeks following surgery or sooner, depending upon the development of new symptoms or new findings during early postoperative examination.
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Provider and Setting

Diagnosis and management of ERM, VMT, or VMA requires special expertise, surgical skills, and specialized equipment to detect alterations in the retina in order to select, perform, implement, and monitor appropriate management or treatment.
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Counseling and Referral

Patients should be informed to notify their ophthalmologist promptly if they have symptoms such as an increase in floaters, a loss of visual field, metamorphopsia, or a decrease in visual acuity.
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Recommendation Grading

Disclaimer

Overview

Title

Idiopathic Epiretinal Membrane and Vitreomacular Traction

Authoring Organization

Publication Month/Year

February 1, 2020

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Describe the pathogenesis of ERM and VMT, recognize symptoms and signs of ERM and VMT. Describe the natural history without treatment and propose a treatment strategy. Educate the patient about treatment options. Optimize visual function and/or relief of symptoms.
 

Inclusion Criteria

Adult, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Diagnosis, Management

Diseases/Conditions (MeSH)

D019773 - Epiretinal Membrane, D057586 - Vitreoretinal Surgery

Keywords

blurred vision, Idiopathic Epiretinal Membrane, Vitreomacular Traction, vision loss

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Idiopathic Epiretinal Membrane and Vitreomacular Traction Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.022

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
131
Literature Search Start Date
April 1, 2018
Literature Search End Date
June 1, 2019