Objective and Quantitative Estimation of the Optimal Timing for Epiretinal Membrane Surgery on the Basis of Metamorphopsia

Abstract

Purpose: To establish an objective and quantitative biomarker of metamorphopsia in epiretinal membranes (ERMs) and determine the optimal timing for ERM surgery.Methods: Retrospectively, 172 eyes with ERM were reviewed. Retinal folds because of tangential traction by ERM were visualized by en-face optical coherence tomography. The maximum depth of retinal folds (MDRF) within the parafovea was quantified. Metamorphopsia was quantified by M-CHARTS. The change in the distance between the retinal vessels after ERM surgery and the preoperative total depth of retinal folds between the vessels were quantified using en-face optical coherence tomography and optical coherence tomography angiography.Results: Significant correlations were observed between preoperative MDRF and M-CHARTS scores before and at 6 months after surgery (r = 0.617 and 0.460, respectively; P , 0.001) and change in the distance between the retinal vessels after ERM surgery and preoperative total depth of retinal folds between the vessels (r = 0.471; P = 0.013). The preoperative MDRF values at which M-CHARTS scores were 0.5 before and 6 months after the surgery were 69 mm and 118 mm, respectively. Conclusion:The MDRF is an objective and quantitative biomarker of metamorphopsia in ERM. To maintain patients' quality of vision, ERM surgery may be performed when the preoperative MDRF ranges between 69 mm and 118 mm.

Quantitative Analyses of Retinal Traction Force and Metamorphopsia in Lamellar Macular Hole and Related Diseases

“…It has been reported that the early manifestation of idiopathic ERM is metamorphopsia rather than visual acuity and that metamorphopsia has a significant impact on the patient's quality of life. 18 , 19 Recently, attempts have been made to determine the surgical indication for idiopathic ERM using MDRF as an objective quantitative parameter to evaluate metamorphopsia, 9 and similar surgical indication criteria should be established for ERM-FS and MPH.…”

“…To quantitatively evaluate the strength of retinal traction, the MDRF was measured according to previous reports. 6 , 7 , 8 , 9 , 10 Briefly, the distance between the ILM surface and the surface on which the deepest retinal folds are seen was measured in the parafoveal area, i.e., a circle 3 mm in diameter centered on the fovea.…”

“…Recently, we focused on the depth of retinal folds visualized with en face imaging and observed that this depth is an important objective and quantitative biomarker that reflects the tangential traction force on the retina due to epiretinal membrane (ERM). 2 , 6 , 7 , 8 , 9 We further examined the relationship between the preoperative maximum depth of retinal folds within the parafovea (MDRF) and metamorphopsia. The MDRF is the distance between the 2 planes of en-face OCT images: 1 on the level of the internal limiting membrane (ILM) and the other through the bottom of the deepest retinal fold within the parafoveal area ( Figure S1 ).…”

Epiretinal Membrane Impairs the Inner Retinal Layer in a Traction Force-Dependent Manner

“…Recently, we focused on the depth of retinal folds caused by ERM and reported that this depth is an important objective and quantitative biomarker reflecting the tangential retinal traction force applied by ERM. 12 , 16 , 17 , 18 , 19 , 20 We further examined the relationship between the preoperative maximum depth of retinal folds within the parafovea (MDRF) and metamorphopsia and found that MDRF was significantly related to preoperative metamorphopsia. 16 , 19 , 21 In addition, utilizing the relationship between MDRF and metamorphopsia, we quantitatively identified the optimal timing of ERM surgery that does not compromise the patient’s quality of life.…”

“… 16 , 19 , 21 In addition, utilizing the relationship between MDRF and metamorphopsia, we quantitatively identified the optimal timing of ERM surgery that does not compromise the patient’s quality of life. 19 …”