This 52-year-old lady was referred by her optometrist for assessment of a left epiretinal membrane (ERM) that was detected at a routine sight test.
This is a single image from an OCT scan of the left macula, passing through the fovea. The most obvious abnormality is the hyperreflective linear structure that appears to lie superficial to the inner retina with associated corrugation of the inner retinal contour and disruption of the foveal architecture. There are associated cystic spaces at the fovea with loss of the foveal depression. The outer retinal layers appear intact with no disruption or distortion of the ellipsoid zone (photoreceptor layer).
The patient was asymptomatic with 6/6 visual acuity in each eye, which fits in with normal appearance of the outer retinal layers. Subtle Amsler distortion was detected at her sight test.
Surgical intervention for epiretinal membrane (i.e. vitrectomy and membrane peel) is more successful at relieving problematic distortion rather than improving visual acuity. This patient was essentially asymptomatic so the referring optometrists was asked whether they would be happy review the patient with a repeat OCT scan in a year’s time, rather than offering the patient an appointment in a surgical retina clinic.
The strongest indication for surgical treatment of epiretinal membranes is to treat bothersome distortion from the affected eye that is intrusive with both eyes open. This patient was asymptomatic so the email exchange between the referring optometrist saved a valuable NHS clinic appointment and meant that the patient would not have to make an additional trip to the eye hospital.