Incidence Rate of Epiretinal Membrane
The annual incidence rate of epiretinal membrane is approximately 9.4 per 100 eye-years, translating to a 5-year cumulative incidence of 37.6% in elderly populations when detected using spectral-domain OCT. 1
Annual Incidence Data
The most robust incidence data comes from longitudinal studies using modern imaging:
In French elderly subjects (mean follow-up 5.09 years): The incidence rate was 9.42 per 100 eye-years (95% CI: 7.36-12.05), corresponding to a 5-year cumulative incidence of 37.6%. 1 This represents the highest quality incidence data available, as it utilized spectral-domain OCT for detection rather than fundus photography alone.
In Korean adults aged 50+ years: The 5-year age-standardized incidence was 3.8% (95% CI: 2.8-4.8), including 2.3% with cellophane macular reflex and 1.5% with preretinal macular fibrosis. 2 This lower rate likely reflects the use of fundus photography rather than OCT.
Age-Specific Considerations
Increasing age is the most consistently identified risk factor across all studies. 3
- The incidence increases progressively with age, though one recent study in English patients over 65 found no additional age-related increase within this elderly cohort. 4
- Peak incidence occurs in the 7th and 8th decades of life. 3
High-Risk Populations
Patients with Diabetes Mellitus
Diabetes and hypercholesterolemia are associated with higher rates of cellophane maculopathy (early ERM). 3
- Diabetic patients without retinopathy show a 3.2-fold increased risk of preretinal macular fibrosis (odds ratio 3.2; 95% CI: 1.4-7.2). 5
- However, one recent study found no significant correlation between diabetes and idiopathic ERM in elderly patients. 4
Patients with Hypercholesterolemia
- Hypercholesterolemia is associated with higher rates of cellophane maculopathy. 3
- Hypertriglyceridemia (≥250 mg/dL) increases risk with an adjusted odds ratio of 3.16 (95% CI: 1.54-6.49). 2
Critical Factors Affecting Incidence Detection
The detection method dramatically impacts reported incidence rates:
- Spectral-domain OCT detects significantly higher rates than fundus photography alone, explaining why the French ALIENOR study found much higher incidence (9.42 per 100 eye-years) compared to earlier photography-based studies. 1
- Studies using OCT in elderly populations document prevalence as high as 34.1%, compared to 2.2-28.9% with fundus photography. 3
Additional Risk Factors for Incident ERM
Beyond age, diabetes, and hypercholesterolemia, the following factors predict new ERM development:
- Vitreomacular or vitreopapillary adhesion at baseline (hazard ratio 2.15; P=0.02) 1
- Choroidal thinning (hazard ratio 1.04 per 10 μm decrease; P=0.02) 1
- ERM in the contralateral eye (P=0.02) 1
- Smoking after age 85 (hazard ratio 6.01; P=0.003) 1
Important Clinical Caveats
Most incident ERMs are idiopathic (90.7%), with only 9.3% being secondary (predominantly post-cataract surgery at 43.5% of secondary cases). 4
The 5-year progression rate from early to advanced ERM is relatively low at 6.9%, suggesting that most ERMs remain stable once formed. 1
Bilateral involvement occurs in 20-35% of cases, necessitating examination of both eyes when ERM is detected. 3
The wide variation in reported incidence (3.8% to 37.6% over 5 years) reflects differences in detection methods, population characteristics, and classification systems rather than true geographic variation. 1, 2