Editor's note: Ophthalmology Times is pleased to recognize Xuejing (Jing) Chen, MD, vitreoretinal fellow, Tufts Medical Center, Ophthalmic Consultants of Boston, as the fifth-place honoree of the inaugural Ophthalmology Times Research Scholar Honoree Program. Dr. Chen’s abstract is featured here. The Ophthalmology Times Research Scholar Honoree Program is dedicated to the education of retina fellows and residents by providing a unique opportunity for fellows/ residents to share notable research and challenging cases with their peers and mentors. The program is supported by unrestricted grants from Regeneron Pharmaceuticals and Carl Zeiss Meditec Inc. To learn more about the program, go to OphthalmologyTimes.com/2017RSH
In the United States, epiretinal membranes (ERMs) affect 30 million adults ages 43 to 86 years.1
The management for ERMs is observation for eyes with tolerable symptoms and surgical membrane peel for eyes with intolerable symptoms. Traditionally, surgery was reserved for eyes with vision 20/50 and worse or with absolutely intolerable symptoms, and patients with better vision were suggested to monitor. More recently, reports on surgery for symptomatic eyes with vision better than 20/50 or 20/60 have indicated favorable outcomes.2–5
These reports suggest that although eyes with good baseline vision have a smaller vision gain from preoperative to postoperative than eyes with worse baseline vision, the eyes with good vision tend to have a better absolute postoperative result, suggesting that advanced ERMs may contain a certain level irreversible vision loss.
For patients with good vision who can currently tolerable their symptoms, a common and important question is the risk of ERM progression. If progression to poor vision is certain within a short time period, then it behooves them to get surgery early and achieve a better absolute postoperative vision. However, if progression to poor vision or intolerable symptoms is prolonged, then the patient may choose to monitor as many are already of advanced age.
Few studies on the natural histories of ERMs exist. The Blue Mountain Study done in Australia showed that in ERM 1/3 progressed, 1/3 regressed, and 1/3 remained stable at 5 years.6
A study by Byon et al.,7 looked at 62 eyes with good vision 20/40 or better and showed that less than 10% had a decrease in vision while 6.5% had an improvement in vision at 2 years. Our study elaborates on these works to look at the progression to surgery for eyes with good vision.