Epiretinal Membrane physiology

[Islandpoet]

My retinal specialist has been checking my epiretinal membrane every 2 months since last fall.  The membrane seems to be very slowly lifting back, and we’re continuing to monitor it.  Here's my question: I often need chiropractic treatments and massage therapy for a neck problem.  Does lying facedown on a head cradle, with some amount of pressure on my eyeballs, have an adverse effect on the ERM attempting to pull itself off?  Am I pressing the ERM back down into the retina? What’s the physiology?  I know surgery is often indicated for ERM, but my vision is improving, so if there's anyway I can support the membrane trying to lift itself off, I'm there!  Thanks.

[JodieJ]

I also had an epiretinal membrane, and I've done a lot of reading on this subject.  Here's my 2 cents:  Spontaneous separation of an epiretinal membrane is an extremely rare event, especially in an adult.  It is generally followed by the onset of many floaters and improved acuity.  I don't believe any type of posturing would have an effect.

Certainly many cases of ERM do not need surgery.  In general, acuity decreases for a couple of months after the ERM is formed and then stabilizes, with little (if any) subsequent loss of acuity.  There is currently accumulating evidence that early surgery to peel the ERM is associated with better visual outcomes.  In addition, the long-term duration of distortion secondary to the ERM may be associated with irreversible damage to the underlying macular tissue.  My point is this:  if you are considering surgery to peel an ERM, it's best not to delay by "observing" things for months or even years.  In the hands of an experienced surgeon, I believe that the risks of surgery are few (mainly accelerated cataract development) and recovery is very rapid.  

[Michael J Kutryb, MD]

I really don't foresee chiropractic care having any effect on your epiretinal membrane but if in doubt please ask your own retinal specialist who is just a phone call away.  If your vision is good or acceptable there is certainly no need for a membrane peel surgery - which could be done pretty much at any time in the future if needed.  Otherwise, there is nothing you can do personally to try to make it better.

Thanks Jodie J for you input which is always very good.

MJK MD

[mike230]

A related discussion, ERM was started.

[sunny112]

I have been diagnosed with macular pucker after 24 injections of Lucentis. Surgery has been suggested. My vision in the affected eye is 20/60 and stable. However, I continue to receive the Lucentis injections for the wet md.  Should I have the surgery? He wants to do the surgery and give me another Lucentis injection during the surgery.