What is the incidence rate of epiretinal membrane development throughout a lifetime?

Incidence Rate of Epiretinal Membrane Development Throughout Lifetime

The incidence rate of epiretinal membrane (ERM) is approximately 9.42 per 100 eye-years, corresponding to a 5-year cumulative incidence of 37.6% in elderly populations, with prevalence increasing dramatically with age from 1.9% in those under 60 to over 11% in those 70-79 years old. 1

Prevalence and Incidence Patterns

Age-Related Prevalence

• Prevalence increases significantly with age 2:
  • 1.9% in persons younger than 60 years
  • 7.2% in persons 60-69 years
  • 11.6% in persons 70-79 years
  • 9.3% in persons 80 years and older

Overall Prevalence

• Estimated to affect approximately 30 million adults in the United States aged 43-86 years 2
• Bilateral in 20-35% of cases 2
• Prevalence varies significantly by population:
  • Low: 2.2-3.4% in Chinese populations 2
  • Moderate: 7-8.9% in Australian populations 2, 3
  • High: 18.8-28.9% among Latinos in Los Angeles and in multi-ethnic U.S. studies 2
  • Very high: 34.1% in elderly populations (mean age 74.1 years) when assessed with SD-OCT 2

Incidence Rates

• 5-year cumulative incidence of 5.3% (95% CI 4.4-6.4) for new ERM development in previously unaffected individuals 4
• Higher incidence rate of 9.42 per 100 eye-years in more recent studies using spectral-domain OCT 1
• 13.5% 5-year risk of developing ERM in the second eye when one eye is already affected 4

ERM Types and Progression

Types of ERM

• Cellophane macular reflex (CMR): Early asymptomatic form without retinal folds
  • Prevalence: 1.8-25.1% depending on population 2
• Preretinal macular fibrosis (PMF): More severe form with retinal folds
  • Prevalence: 0.7-3.9% across different populations 2

Natural History

• Progression from CMR to PMF occurs in approximately 9.3% of eyes over 5 years 4
• Existing ERMs show variable course over 5 years 4:
  • Progress in 28.6% of cases
  • Regress in 25.7% of cases
  • Remain stable in 38.8% of cases
• 5-year cumulative progression rate of 6.9% in recent studies 1

Risk Factors

Established Risk Factors

• Age: Most consistent and significant risk factor across all studies 2
• Ethnicity: Varies by population, with highest rates in Chinese Americans (39.0%), followed by Hispanics (29.3%), whites (27.5%), and lowest in blacks (26.2%) 2
• Vitreous status: Vitreomacular or vitreopapillary adhesion increases risk (HR 2.15) 1
• Contralateral eye involvement: Significantly increases risk of developing ERM in the second eye 1
• Ocular conditions:
  • Cataract surgery (9.1% incidence vs. 4.9% in non-surgical eyes) 4
  • Retinal vascular disease (particularly retinal vein occlusions) 2
  • Uveitis and ocular inflammatory diseases 2
  • Retinal breaks 2
  • Diabetic retinopathy 2

Other Potential Risk Factors

• Choroidal thinning 1
• Smoking after age 85 (HR 6.01) 1
• Diabetes and hypercholesterolemia (associated with cellophane maculopathy) 2

Clinical Implications

• Most ERMs remain relatively stable and asymptomatic, not requiring treatment 5
• Approximately 80% of patients with symptomatic ERMs improve by at least 2 lines of visual acuity after vitrectomy surgery 5, 6
• PMF has a small but significant effect on visual acuity, while CMR generally does not affect vision 3
• In patients with vitreomacular traction of 1500 μm or less, spontaneous release occurs in approximately 30-40% of eyes over 1-2 years 5

Diagnostic Considerations

• OCT is the diagnostic method of choice for classifying ERMs 5
• OCT findings include:
  • Hyperreflective irregular layer on inner retinal surface
  • Retinal folds
  • Macular thickening
  • Possible cystic spaces in various retinal layers
  • Elevation of normal foveal depression

The high variability in reported prevalence rates across studies is likely due to differences in imaging modalities (with SD-OCT detecting more cases), classification criteria, and population characteristics including age and ethnicity 2, 1.