Age-related macular degeneration (AMD) and epiretinal membrane (macular pucker) are two conditions that can affect the macula, a small part of the retina that helps you see in sharp detail. Although AMD and macular pucker affect the same part of your eye, the two conditions have key differences in their symptoms, complications, causes, and treatments.

Epiretinal membrane and AMD share a few similarities, too. It’s important to be aware of which condition you have so you and your ophthalmologist can manage it effectively.

Let’s take a closer look at the similarities and differences between AMD and macular pucker.

7 Differences Between Epiretinal Membrane and AMD

Epiretinal membrane and AMD can be related. Research suggests that having epiretinal membrane can influence the course and treatment of AMD. One doesn’t cause the other, but it’s possible to have both at the same time.

Here are seven ways that AMD and epiretinal membrane differ, including a few that highlight how one condition can influence the other:

1. AMD and Epiretinal Membrane Affect the Macula Differently

Both AMD and epiretinal membrane involve changes to the macula. However, the changes aren’t the same and can result in different types of vision change.

If you have epiretinal membrane, a layer of scar tissue has formed on the surface of the retina over the macula. Underneath the scar tissue, the retina can twist, wrinkle, or “pucker.” This puckering is what causes distorted vision.

The macular changes in AMD depend on the type of AMD you have. If you have dry AMD, the more common type, small yellow protein deposits develop on the macula. They can then dry out, which causes the macula to thin and wear down over time.

Wet AMD is the less common but more severe type. In wet AMD, the damage happens because abnormal blood vessels form beneath the macula. Those vessels ooze fluid and blood, which can cause the macula to bulge and distort. When this happens, you can lose your central vision very quickly.

2. Macular Pucker May Not Have Symptoms

In dry AMD, symptoms can progress slowly enough that you may not realize you have it at first. But as time goes on, vision changes like poor night vision and blurry vision usually become harder to ignore.

While epiretinal membrane commonly causes vision distortions like wavy or out-of-focus vision, some people’s brains adapt to the changes so effectively that they don’t notice any visual distortions.

3. AMD Progresses

AMD is a progressive condition, meaning its symptoms worsen over time. Dry AMD progresses slowly, while wet AMD can cause rapid vision loss.

Does epiretinal membrane get worse? It can, but this isn’t always the case. The vision changes from an epiretinal membrane may never be noticeable, or they may remain stable and manageable.

4. Epiretinal Membrane and AMD Can Influence Each Other’s Progression and Outcome

Research suggests that having an epiretinal membrane might influence the progression of AMD.

Some people with AMD develop acquired vitelliform lesions (AVLs), which are yellow deposits under the retina that look similar to drusen, extracellular deposits that also form under the retina. However, AVLs can appear beneath the macula even if there are no drusen.

A study of the effect of epiretinal membrane on AMD found that in people with epiretinal membrane, AVLs were significantly larger than in people without epiretinal membrane. AVLs are associated with a higher risk of AMD progression to vision loss.

On the other hand, drusen from AMD may also influence symptoms of epiretinal membrane. They may also affect the results of eye surgery for epiretinal membrane.

5. Epiretinal Membrane Might Make Some AMD Treatments Less Effective

Research on epiretinal membrane and AMD also indicates that epiretinal membrane can reduce the effectiveness of certain AMD treatments.

An epithelial membrane can make it harder for wet AMD drugs like anti-vascular endothelial growth factor (anti-VEGF) injections to reach the macula. Anti-VEGF medications treat wet AMD by stopping the development of new blood vessels beneath the retina.

6. Epiretinal Membrane Causes Complications Beyond Vision Loss

The main complication in AMD is central vision loss, which can be severe enough to be classified as legal blindness.

Although epiretinal membrane also causes vision decline, its complications don’t stop there. It can also lead to:

• Bleeding in the retina
• Macular hole

A macular hole is a hole that develops in the macula. It’s considered a complication of epiretinal membrane, though it can happen to anyone (especially with age). A macular hole can increase vision problems related to epiretinal membrane, and it can even lead to a blind spot in the center of your vision in advanced cases.

7. Surgery May Be Recommended for Epiretinal Membrane

Surgery usually isn’t recommended to treat AMD. There are drugs and procedures available for treating wet AMD, but no surgical options.

Your ophthalmologist might recommend surgery to treat epiretinal membrane if you have a high risk of experiencing complications. The surgery, called vitrectomy, removes the layer of scar tissue from your retina.

Join the Conversation

On myAMDteam, people share their experiences with age-related macular degeneration, get advice, and find support from others who understand.

How has epiretinal membrane affected your vision? Let others know in the comments below.