Vision may improve after epiretinal membrane (ERM) surgery—but it’s the final acuity levels that matters most to patients, said Colin A. McCannel, MD, on Friday during Retina Subspecialty Day. Studies should report the likelihood of excellent vision in patients with ERM, he said, so that surgeons can better plan their approach.
ERM peeling is not done soon enough. Patients with ERM often seek surgery when their vision declines to 20/70 or worse. But by this point, the results of ERM peeling may not be satisfactory: 2 lines of visual acuity improvement, on average, with a modest improvement in metamorphopsia.
“These historical surgical indications leave patients with suboptimal visual acuity and low satisfaction,” said Dr. McCannel.
Setting goals for ERM surgery. He proposes that retina surgeons strive for excellent visual acuity and function—along the lines of 20/20 to 20/25, with minimal metamorphopsia.
What’s the best timing for surgery? Early intervention can help surgeons meet this goal, said Dr. McCannel. But how early is early enough? The answer is unclear, he said, in part because most ERM peeling studies report the amount of visual improvement rather than final acuity level. Reporting the likelihood of excellent vision would better guide surgeons.
A pilot study provides some pointers. In a pilot study of 46 consecutive ERM peeling surgeries performed in his practice, Dr. McCannel found that 100% of patients with a visual acuity of 20/30 or better before surgery achieved a final visual acuity of 20/25 or better. When preoperative visual acuity fell in the range of 20/40 to 20/60, only half of the eyes achieved a final visual acuity of 20/25 or better. And when preoperative visual acuity was 20/70 or worse, less than one-third of eyes achieved a final visual acuity of 20/25 or better.
No patients developed endophthalmitis and only 1 had a retinal detachment, suggesting that the potential visual benefits of early intervention may outweigh the risks.
“Clearly, preoperative visual acuity matters in final outcomes,” said Dr. McCannel.—Anni Griswold
Financial disclosures. Dutch Ophthalmic Research Company: C; Genentech: R.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.
Next story from AAO 2018—Minimize Problems in Retinal Detachment Surgery: Steven T. Charles, MD, on the role played by visualization and conceptualization in retinal detachment surgery.