Prevalence Of Epiretinal Membranes Research Articles

Development of a generative deep learning model to improve epiretinal membrane detection in fundus photography

BackgroundThe epiretinal membrane (ERM) is a common retinal disorder characterized by abnormal fibrocellular tissue at the vitreomacular interface. Most patients with ERM are asymptomatic at early stages. Therefore, screening for ERM will become increasingly important. Despite the high prevalence of ERM, few deep learning studies have investigated ERM detection in the color fundus photography (CFP) domain. In this study, we built a generative model to enhance ERM detection performance in the CFP.MethodsThis deep learning study retrospectively collected 302 ERM and 1,250 healthy CFP data points from a healthcare center. The generative model using StyleGAN2 was trained using single-center data. EfficientNetB0 with StyleGAN2-based augmentation was validated using independent internal single-center data and external datasets. We randomly assigned healthcare center data to the development (80%) and internal validation (20%) datasets. Data from two publicly accessible sources were used as external validation datasets.ResultsStyleGAN2 facilitated realistic CFP synthesis with the characteristic cellophane reflex features of the ERM. The proposed method with StyleGAN2-based augmentation outperformed the typical transfer learning without a generative adversarial network. The proposed model achieved an area under the receiver operating characteristic (AUC) curve of 0.926 for internal validation. AUCs of 0.951 and 0.914 were obtained for the two external validation datasets. Compared with the deep learning model without augmentation, StyleGAN2-based augmentation improved the detection performance and contributed to the focus on the location of the ERM.ConclusionsWe proposed an ERM detection model by synthesizing realistic CFP images with the pathological features of ERM through generative deep learning. We believe that our deep learning framework will help achieve a more accurate detection of ERM in a limited data setting.

Presentation of cases who underwent vitrectomy for the management of idiopathic epiretinal membranes (iERM)

Epiretinal membrane (ERM) is a term used to describe cellular avascular membranes that form on the inner retinal surface, causing distortion and a decrease in the best corrected visual acuity (BCVA). The prevalence of ERM ranges from 7% to 29% in the general population. Pre‐macular fibroplasia, macular pucker, cellophane maculopathy and pre‐macular fibrosis have also been used to describe this condition. The majority of ERM's have no associated ocular abnormality and are termed idiopathic while the secondary ERM's are associated with preexisting or coexisting conditions such as diabetic retinopathy, cataract surgery, retinal detachment and retinal detachment surgery.Patients with ERM are usually monitored by measuring BCVA and retinal morphology. Last decades a valuable tool in diagnosis, grading, follow up and post‐surgical evaluation of ERM is Optical Coherence Tomography (OCT). OCT can demonstrate the presence of ERM, degree of traction, the presence of cystoid macular edema and various biomarkers such us the disorganization of the inner retinal layers (DRIL).ERM may remain stationary with minimal effect on visual performance. However, some cases may progress with worsening of symptoms, increasing retinal thickness and traction. In those symptomatic cases, surgical peeling of ERM through pars plana vitrectomy (PPV) is the treatment of choice. Some surgeons prefer to peel the Internal limiting membrane (ILM) during primary vitrectomy. Previous studies showed that 40–83% of patients gain on average of 2 or more lines of BCVA after ERM surgery.We present three cases of successful surgical ERM repair. The first patient had a longstanding ERM with DRIL, his symptoms were metamorphopsia and low vision. One month following vitrectomy gained 5 lines. BCVA improved from CF pre‐op to 5/10 Snellen chart 1 month post‐op, with good macular anatomical restoration. The second patient, 1 month postoperatively, had also good anatomical result but presented an eccentric macular hole even though we did not perform an ILM peel. The third patient, 18 months after a successful vitrectomy for ERM peel in his only eye and BCVA 8/10 cc on Snellen chart the first 6 months, he experienced a decline in his vision and an OCT revealed a full thickness macular hole. Hence, a second operation was performed with ILM peel and good anatomical and functional restoration.

LONG-TERM PROGRESSION PATTERN OF MYOPIC TRACTIONAL MACULOPATHY: Outcomes and Risk Factors.

To evaluate the long-term progression pattern of myopic tractional maculopathy and the risk factors. The prevalence and grade of myopic tractional maculopathy were assessed with optical coherence tomography at enrollment and at the 2-year follow-up. The severity of posterior staphyloma and the presence of dome-shaped macula were also evaluated. In total, 610 highly myopic eyes of 610 patients were analyzed. The prevalence of epiretinal membrane, myopic retinoschisis, and macular hole increased from 26.7%, 12.1%, and 4.4% at enrollment to 41.1%, 18.2%, and 9.5% at the 2-year follow-up, respectively. Epiretinal membrane progressed in 21.8% of eyes, but visual acuity did not decline significantly in these eyes. Myopic retinoschisis progressed in 6.8% of eyes, and macular hole progressed in 14.8% of eyes. Significantly greater best-corrected visual acuity reduction was detected in the eyes with myopic retinoschisis or macular hole progression than the rest ( P < 0.05). Multivariate analysis showed that longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were associated with myopic tractional maculopathy progression. In highly myopic eyes, long-term visual acuity was relatively stable in those with epiretinal membrane, but was significantly affected by myopic retinoschisis or macular hole progression. Longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were risk factors for myopic tractional maculopathy progression.

Prevalence and risk factors of epiretinal membrane: Data from the Korea National Health and Nutrition Examination Survey VII (2017-2018).

To determine the prevalence and risk factors of epiretinal membrane (ERM) utilising spectral-domain optical coherence tomography (SD-OCT). We investigated data from the 2017 to 2018 Korea National Health and Nutrition Examination Survey. Individuals aged ≥40 years with readable fundus photographs and SD-OCT results were included. ERM was diagnosed by fundus photography and OCT. The following data was collected: demographics, health interview, health examination, and nutritional survey results. The prevalence of ERM was estimated and risk factors for ERM were analysed. A total of 6807 participants were finally included. Adjusted prevalence of ERM was 7.0% (95% confidence interval, 6.3%-7.8%). Multivariate logistic regression analysis revealed that age ≥ 50 years (p< 0.001 for all age groups), history of cataract surgery (p< 0.001), well-controlled hypertension (p= 0.006), and diabetic retinopathy (p= 0.041) were risk factors for ERM. The estimated prevalence of ERM was 7.0%, which was higher than that of previous reports using fundus photography only in an East Asian population. Possible risk factors for ERM were older age, history of cataract surgery, hypertension, and diabetic retinopathy.

Risk factors for epiretinal membrane in eyes with primary rhegmatogenous retinal detachment that received silicone oil tamponade

Background/aimsThis study investigated the risk factors for epiretinal membrane (ERM) in eyes with primary rhegmatogenous retinal detachment (RRD) that received silicone oil (SO) tamponade.MethodsThis retrospective analysis included 1140 patients (1140...

Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment.

The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade. The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed. 48 patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6 and 100% vs 100%, all P values > 0.05). Postoperative best-corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2 ± 0.4 vs 2.6 ± 0.5, P < 0.001 and 0.1 ± 0.4 vs 0.4±0.9, P = 0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02). Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.

Comparison of the Prevalence and Clinical Characteristics of Epiretinal Membrane in Pseudoexfoliation and Primary Open-angle Glaucoma.

The purpose of this study was to investigate and compare the prevalence and clinical characteristics of epiretinal membrane (ERM) in patients with pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG). In this retrospective observational study, 211 PXG eyes, 210 age-matched normal eyes, and 220 POAG eyes were included. The presence and staging of ERM (stage 1, 2, and 3 or greater) were independently assessed by 2 observers. Univariate and multivariate linear regression analyses were performed to assess the factors associated with visual field (VF) mean deviation (MD) in PXG eyes. Among 211 PXG eyes, 40 (19.0%) had an ERM, while 4.1% of POAG and 2.4% of normal eyes had an ERM (P<0.001). Retinal nerve fiber layer thickness (69.4 vs. 70.4 μm, P=0.477) and VF MD (-7.7 vs. -10.4 dB, P=0.098) were not different between POAG and PXG eyes but macular thickness was greater (259.5 vs. 271.5 μm, P=0.006) in PXG eyes than in POAG. Both lower retinal nerve fiber layer thickness (β=0.337, P<0.001) and the presence of an ERM (β=-4.246, P=0.002) were independently associated with worse VF MD in PXG eyes. The prevalence of ERM was significantly greater in PXG eyes than in age-matched normal or POAG eyes. The presence of ERM affected VF in PXG eyes.

Epiretinal membrane: A review

The prevalence of epiretinal membrane (ERM) is 7% to 11.8%, with increasing age being the most important risk factor. Although most ERM is idiopathic, common secondary causes include cataract surgery, retinal vascular disease, uveitis and retinal tears. The myofibroblastic pre-retinal cells are thought to transdifferentiate from glial and retinal pigment epithelial cells that reach the retinal surface via defects in the internal limiting membrane (ILM) or from the vitreous cavity. Grading schemes have evolved from clinical signs to ocular coherence tomography (OCT) based classification with associated features such as the cotton ball sign. Features predictive of better prognosis include absence of ectopic inner foveal layers, cystoid macular oedema, acquired vitelliform lesions and ellipsoid and cone outer segment termination defects. OCT-angiography shows reduced size of the foveal avascular zone. Vitrectomy with membrane peeling remains the mainstay of treatment for symptomatic ERMs. Additional ILM peeling reduces recurrence but is associated with anatomical changes including inner retinal dimpling.

Retinal capillary involvement in early post-COVID-19 patients: a healthy controlled study

BackgroundSystemic vascular involvement in COVID-19 has been identified in several patients: not only endothelial derangement and increased permeability are reported to be early hallmarks of organ damage in patients with COVID-19 but are also the most important cause of worsening of clinical conditions in severe cases of SARS-CoV-2 infection. There are several reasons to hypothesize that the eye, and the retina in particular, could be a target of organ damage in SARS-CoV-2 infection.MethodsThis cohort observational study analyzes OCT angiography and structural OCT of 70 post-COVID-19 patients evaluated at 1-month hospital discharge and 22 healthy control subjects. Primary outcomes were macular vessel density (VD) and vessel perfusion (VP); structural OCT features were evaluated as secondary outcomes. In addition, patients and healthy volunteers were evaluated for best corrected visual acuity, slit lamp photograph, and fundus photo image.ResultsVD and VP in 3 × 3 and 6 × 6 mm scans for SCP and DCP showed no significant differences between the groups. Similarly, CMT and GCL did not reveal significant differences between post-COVID-19 and healthy patients. Nine patients (12.9%) featured retinal cotton wool spots and 10 patients had vitreous fibrillary degeneration. The prevalence of epiretinal membrane and macular hole was similar in the two groups. One case of extra papillary focal retinal hemorrhage was reported in the post-COVID-19 group.ConclusionsMacula and perimacular vessel density and perfusion resulted unaltered in mild post-COVID-19 patients at 1-month hospital discharge, suggesting no or minimal retinal vascular involvement by SARS-CoV-2.

Prevalence of Epiretinal Membrane among Subjects in a Health Examination Program in Japan.

The prevalence of an epiretinal membrane (ERM) was elucidated using a dataset from a health examination program database in Japan. From the cohort database, 5042 eyes of 2552 subjects were included. The presence of an ERM, cellophane macular reflex (CMR), or preretinal macular fibrosis (PMF) was detected using color fundus photographs, and crude and age-standardized prevalence were obtained. To further assess the possible risk factors of ERM, background parameters were compared between ERM+ and − groups, and multiple logistic regression analysis was performed. ERM was detected in fundus photographs of 275 eyes (eye-based prevalence of 5.5%) from 217 subjects (subject-based prevalence of 8.5%). CMR was detected in 169 eyes (3.4%) of 138 subjects (5.4%), and PMF was detected in 106 eyes (2.1%) of 97 subjects (3.8%). By univariate analyses, compared with ERM− eyes or subjects, higher Scheie’s H grade (p < 0.0001), S grade (p < 0.0001), and glaucoma prevalence (p = 0.0440) were found in ERM+ eyes, and older age (p < 0.0001), more frequent histories of hypertension (p = 0.0033) and hyperlipidemia (p = 0.0441), and more frequent uses of medication for hypertension (p = 0.0034) and hyperlipidemia (p = 0.0074), shorter body height (p = 0.0122), and higher systolic blood pressure (p = 0.0078), and thicker intimal medial thickness (p = 0.0318) were found in ERM+ subjects. By multivariate analyses, older age (p < 0.0001, estimate = 0.05/year) was the only significant factor of ERM prevalence. Age-standardized prevalence of ERM was calculated to be 2.4%, 6.7%, and 13.3% for all ages, subjects older than 40 years, and subjects older than 65 years, respectively. We reported the prevalence of ERM and its subclasses in Japanese subjects. Since its prevalence is remarkably high in older subjects, an ERM can be seen as an important cause of visual impairment in Japan and in areas of the world where individuals live to an advanced age.

Prevalence of epiretinal membrane in the phakic eyes based on spectral-domain optical coherence tomography

The prevalence of epiretinal membrane (ERM) and associated factors in the phakic eyes have not been fully elucidated yet. This cross-sectional study included 2,354 phakic eyes without retinal diseases or surgical history. Ocular parameters, such as uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), white-to-white corneal diameter (WTW), mean keratometric value (Km) of total corneal refractive power at 4-mm diameter (TCRP4), astigmatism of TCRP4, total corneal irregular astigmatism (TCIA), pupil diameter, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), and posterior vitreous detachment (PVD) were compared between ERM group and control group. Additionally, an age-matched control group was selected by individual matching and compared with the ERM group to eliminate the confounders. Multiple logistic regression analysis was performed to evaluate the factors associated with the presence of ERM. Among 2,354 eyes, 429 eyes (18.2%) had ERM based on spectral-domain optical coherence tomography. The ERM group showed higher prevalence of PVD, worse CDVA, higher astigmatism of TCRP4, higher TCIA, smaller pupil size, longer AXL, and thicker LT than control group (P < 0.001, P < 0.001, P = 0.011, P < 0.001, P = 0.023, P < 0.001, and P < 0.001, respectively). Only PVD, CDVA, SE, astigmatism of TCRP4, TCIA, and AXL maintained the significance when compared with the age-matched control group (P < 0.001, P = 0.026, P < 0.001, P = 0.001, P = 0.003, and P < 0.001, respectively). Multivariate logistic regression analysis showed that age, PVD, CDVA, and TCIA were independently associated with the presence of ERM (P < 0.001, P < 0.001, P = 0.011, and P = 0.002). The prevalence of ERM detected using SD-OCT was 18.2% in the middle aged phakic population. Eyes with TCIA, in addition to older age and PVD, were more likely to have ERM.

Effectiveness of ocriplasmin in real-world settings: A systematic literature review, meta-analysis, and comparison with randomized trials.

PurposeEffectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta‐analysis of ocriplasmin studies conducted in real‐world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs).MethodsWe included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end‐points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta‐regression on pooled results to evaluate effects of baseline covariates and study design on outcomes.ResultsThirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18–2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08–0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression.ConclusionsOcriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.

Relationship between nerve fiber layer defect and the presence of epiretinal membrane in a Japanese population: The JPHC-NEXT Eye Study

The study subjects were residents of Chikusei city, Japan, aged 40 years or older who attended annual health check-up programs and participated in the JPHC-NEXT Eye Study which performed non-mydriatic fundus photography of both eyes. The relationship of glaucomatous fundus changes such as optic disc cupping (cup to disc ratio ≥ 0.7) and retinal nerve fiber layer defect (NFLD) with the presence of epiretinal membrane (ERM) were examined cross-sectionally. A total of 1990 persons gave consent to participate in this study in 2013. The overall prevalence of ERM was 12.9%. Of these, 1755 had fundus photographs of sufficient quality and no history of intraocular surgery (mean age: 62.3 ± 10.0 years). After adjusting for age, sex and refractive error, NFLD was positively associated with the presence of ERM (odds ratio [OR]: 2.48; 95% confidence interval [CI]: 1.24, 4.96; P = 0.010), but optic disc cupping was not (OR: 1.33; CI: 0.71, 2.48; P = 0.37). The results did not necessarily suggest an association between glaucoma and ERM, but indicated an association between NFLD and ERM.

Pathogenesis of idiopathic epiretinal membrane

AbstractTo describe the pathophysiological events involved in the formation and progression of epiretinal membranes (ERMs).Epidemiologic studies have found a clear relationship between ERM formation, ageing, and posterior vitreous detachment. Increased prevalence of ERM is noted in the population older than 60 years, with peak prevalence between 70 and 79 years. Histologic studies of surgically obtained ERM specimens identified cellular and extracellular matrix components. A key element in ERM formation and its progression toward a contractile membrane is the transdifferentiation of those cellular components toward myofibroblasts. ERMs stiffness is a result of the proportion between its collagenous and non‐collagenous elements. Additionally, modifications of membrane macromolecules, such as accumulation of advanced glycation end products, which constitutes an age‐related phenomenon, may increase stiffness of the membrane and contribute to the fibrotic process.Retinal membranes have been described for more than 150 years and comprise the most common type of fibrocellular proliferation found at the vitreoretinal interface. Although patients with ERM can be asymptomatic when the membrane is thin and translucent, its progression to a thick, and contractile membrane may result in macular distortion, inducing metamorphopsia and loss of visual function. Understanding disease pathogenesis is essential in order to develop appropriate therapeutic approaches.

Pathophysiology, Classification, Clinical Diagnosis and Treatment of Primary Epiretinal Membrane

Epiretinal membrane (ERM), also known as macular pucker, premacular fibroplasia, premacular gliosis, or cellophane maculopathy is a common vitreoretinal interface pathology that can result in mild to moderate visual impairment with an impact on the quality of life. ERM can be classified as primary “idiopathic” or secondary. Most ERMs occur in individuals older than 50 years, and the prevalence of ERM increases as age increases. The pathological mechanisms are not entirely known, however, the posterior vitreous detachment is thought to be key. Diagnosis and classification of ERM are based on clinical examination findings. However, high resolution spectral domain-optic coherence tomographies (SD-OCTs) have proven to be more sensitive than clinical examination for the diagnosis of numerous disorders of the vitreomacular interface, including ERM. SD-OCTs enable the pre-and postoperative comparison of macular structures in a non-invasive examination. In treatment, surgical intervention entails pars plana vitrectomy with ERM removal with or without internal limiting membrane (ILM) removal. Good visual recovery was present in most patients after surgery.

Prevalence of optical coherence tomography detected vitreomacular interface disorders: The Maastricht Study.

PurposeTo calculate the prevalence of all vitreomacular interface (VMI) disorders and stratify according to age, sex and (pre)diabetes status.MethodsThe presence of VMI disorders was assessed in 2660 participants aged between 40 and 75 years from The Maastricht Study who had a gradable macular spectral‐domain optical coherence tomography (SD‐OCT) volume scan in at least one eye [mean 59.7 ± 8.2 years, 50.2% men, 1531 normal glucose metabolism (NGM), 401 prediabetes, 728 type 2 diabetes (DM2, oversampled)]. A stratified and multivariable logistic regression analysis was used.ResultsThe prevalence of the different VMI disorders for individuals with NGM, prediabetes and DM2 was, respectively, 5.7%, 6% and 6.7% for epiretinal membranes; 6%, 9.6% and 6.8% for vitreomacular traction; 1.1%, 0.7% and 0.3% for lamellar macular holes; 0.1%, 0% and 0% for pseudoholes; 1.1%, 1.9% and 5.5% for macular cysts. None of the participants was diagnosed with a macular hole. The prevalence of epiretinal membranes, vitreomacular traction and macular cysts was higher with age (p < 0.001). Vitreomacular traction and lamellar macular holes were more frequent in women (p < 0.01). DM2 is positively associated [OR = 3.9 (95% CI 2.11–7.22, p < 0.001)] with macular cysts and negatively associated with lamellar macular holes [OR = 0.2 (95% CI 0.04–0.9, p = 0.036)] after adjustment for age and sex. The calculated prevalence of VMI disorders was 15.9%.ConclusionsThe calculated prevalence of VMI disorders in individuals aged between 40 and 75 years is 15.9%. The prevalence depends on age, sex and glucose metabolism status for several types of VMI disorders.

Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies

ObjectiveThis study was to aggregate the prevalence and risks of epiretinal membranes (ERMs) and determine the possible causes of the varied estimates.DesignSystematic review and meta-analysis.Data sourcesThe search strategy was designed...

Epiretinal Membrane: Prevalence and Risk Factors from the Korea National Health and Nutrition Examination Survey, 2008 through 2012.

PurposeTo investigate the prevalence and risk factors for an epiretinal membrane (ERM) in Korean population.MethodsUsing the database of the Korea National Health and Nutrition Examination Survey from 2008 through 2012, 14,772 participants 40 years of age or older with gradable fundus photographs were included. The presence of ERM was determined by using fundus photographs. The prevalence of ERM was estimated and possible risk factors including systemic factors, nutritional status, and blood tests were analyzed via multiple logistic regression analyses.ResultsThe prevalence of ERM was 2.9% (95% confidence interval [CI], 2.6% to 3.3%). On multiple logistic regression analysis, the prevalence of ERM was affected by age. The odds ratios (ORs) against the forties were 2.70, 5.48, and 5.69 in the fifties, sixties, and seventies, respectively. ERM was also significantly affected by cataract surgery (OR, 2.82; 95% CI, 2.08 to 3.81) and by the increase in intake of 100-mg calcium (OR, 1.05; 95% CI, 1.00 to 1.11). ERM had negative associations with red blood cell count (OR, 0.66; 95% CI, 0.45 to 0.95).ConclusionsThe estimated nation-wide prevalence of ERM in Korea is 2.9%. The presence of ERM in the general population is associated with age, cataract surgery, increased dietary calcium, and a low red blood cell count.

Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study.

To examine prevalence and risk factors of epiretinal membrane (ERM) in a large, contemporary, multiethnic Asian population. Combined analysis of three population-based studies of eye diseases, with a total of 9799 Chinese, Malays and Indians residing in the general communities of Singapore. A comprehensive ophthalmic examination, interviews and laboratory blood tests were performed to assess potential risk factors. Digital retinal photographs were used to assess ERM according to a standardised protocol. ERM was classified into cellophane macular reflex (CMR) and/or preretinal macular fibrosis (PMF), and also as primary or secondary (in eyes with other retinal pathology or a history of cataract surgery). The age-standardised and ethnicity-standardised prevalence was 12.1% for any ERM, 6.8% for CMR, 6.7% for PMF and 2.8% for bilateral ERM. ERM prevalence was higher in Chinese (13.0%) compared with Malays (7.9%) or Indians (8.7%). In multivariate analysis, significant factors associated with primary ERM were older age (OR 1.08 per year increase; p<0.01), Chinese ethnicity (OR 1.60 vs Indians; p<0.01; OR 1.39 vs Malays; p<0.01), smoking (OR 0.70; p=0.01), longer axial length (OR 1.07 per mm increase; p=0.03) and cataract (OR 0.64; p<0.01). Significant factors independently associated with secondary ERM were older age (OR 1.05; p<0.01), cataract surgery (OR 10.6; p<0.01) and diabetic retinopathy (OR 2.48; p<0.01). ERM is common in Asians, particularly among Chinese. Older age is the most consistent risk factor for any ERM, and previous cataract surgery and diabetic retinopathy are the strongest risk factors for secondary ERM.

Epiretinal membrane in diabetes mellitus patients screened by nonmydriatic fundus camera

ObjectiveTo determine the prevalence of epiretinal membrane (ERM) in patients with type 2 diabetes mellitus (T2DM) and to assess the associated risk factors. DesignRetrospective, cross sectional study. MethodsPatients with T2DM, seen for annual follow-up between 2009 and 2010, were evaluated by digital nonmydriatic retinal photography for the detection of diabetic retinopathy. Retinal photographs were assessed by a retina specialist. ResultsERM was present in 102 of 1550 patients with T2DM (6.5%). Of the participants, 1443 had sufficient documented data to conduct statistical analysis for variant risk factors. The prevalence of ERM was significantly associated with age (p < 0.001; 1.2% for <49 years, 4% for 50–59 years, 8.2% for 60–69 years, and 9.6% for >70 years), cataract surgery (p < 0.001), diabetic nephropathy (p < 0.001), and chronic renal failure (p = 0.039). Prevalence was similar for both sexes (53% females, 47% males; p = 0.33). In logistic regression models, the prevalence of ERM was significantly associated with increasing age (p = 0.018), cataract surgery (p < 0.001), and diabetic nephropathy (p = 0.011). ConclusionsThe prevalence of ERM in patients with T2DM in the present study was not significantly different than that of the general population. ERM was significantly associated with age, diabetic nephropathy, and cataract surgery.