• AAO PPP Retina/Vitreous Committee, Hoskins Center for Quality Eye Care


    By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,1 Ron A. Adelman, MD, MPH, MBA, FACS,2 Steven T. Bailey, MD,3 Amani Fawzi, MD,4 Jennifer I. Lim,5 MD. G. Atma Vemulakonda, MD,6 Gui-shuang Ying, MD, PhD7

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the PPP on the journal's collection page.

    1Casey Eye Institute, Oregon Health & Science University, Portland, OR

    2Yale University Eye Center, New Haven, CT

    3Casey Eye Institute, Oregon Health & Science University, Portland, OR

    4Feinberg School of Medicine, Northwestern University, Chicago, IL 

    5University of Illinois at Chicago, Chicago, IL

    6Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA

    7Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    Highlighted Findings and Recommendations for Care


    Risk factors for epithelial membrane (ERM) include increasing age, other retinal pathologies (e.g., posterior vitreous detachment [PVD]), uveitis, retinal breaks, retinal vein occlusions, diabetic retinopathy4,5, and ocular inflammatory diseases).


    The majority of ERMs will remain relatively stable and do not require therapy. In patients who have areas of vitreomacular traction (VMT) of 1500 µm or less, the incidence of spontaneous release of traction from the macula occurs in approximately 30% to 40% of eyes over a follow-up of 1 to 2 years.


    Spectral-domain optical coherence tomography (SD-OCT) is a highly sensitive and routine methodology used to diagnose and characterize ERM, VMT, and associated retinal changes.


    Vitrectomy surgery is often indicated in affected patients who have a decrease in visual acuity, metamorphopsia, double vision, or difficulty using their eyes together. Vitrectomy for ERM or VMT usually leads to improvement of the metamorphopsia and visual acuity. On average, approximately 80% of patients with ERM or VMT will improve by at least 2 lines of visual acuity following vitrectomy surgery.