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Upon completion of this activity, participants will be able to:
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1.
Describe long-term progression of iERMs in eyes with good baseline visual acuity, according to a retrospective case series
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2.
Determine predictors of visual decline in iERMs in eyes with good baseline visual acuity, according to a retrospective case series
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Explain factors associated with earlier surgical intervention for iERMs in eyes with good baseline visual acuity, according to a retrospective case series
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Authors/Editors disclosure information
S.S. has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Heidelberg Pharma GmbH; Novartis Pharmaceuticals Corporation; Optos; Roche. Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; Bayer AG; Novartis Pharmaceuticals Corporation; Optos. Received grants for clinical research from: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Optos. L.S.M. has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Genentech, Inc.; IRIDEX Corporation. Served as a speaker or a member of a speakers bureau for: Genentech, Inc.; IRIDEX Corporation. Received grants for clinical research from: Genentech, Inc. S.S.P. has disclosed the following relevant financial relationships: Received grants for clinical research from: Allergan, Inc.; Roche/Novartis Pharmaceuticals Corporation. G.Y. has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Alimera Sciences; Allergan, Inc.; Carl Zeiss Meditec; IRIDEX Corporation. Received grants for clinical research from: Alcon Laboratories, Inc.; IRIDEX Corporation. K-Y.L., T.K., A.Y., L.M., B.P.D-J., A.M. have disclosed no relevant financial relationships.
Journal CME author disclosure information
Laurie Barclay has disclosed no relevant financial relationships.
Abstract
Background/objectives
To evaluate the long-term progression of idiopathic epiretinal membranes (iERMs) with good baseline visual acuity, and to identify predictors of visual decline.
Design
Retrospective case series
Subjects methods
We reviewed records of 145 eyes with iERM and best-corrected visual acuity (BCVA) of 20/40 or greater at presentation, including BCVA, lens status, and central macular thickness (CMT) at yearly visits; as well as anatomic biomarkers including vitreomacular adhesion, pseudohole, lamellar hole, intraretinal cysts, disorganization of the inner retinal layers (DRIL), and disruption of outer retinal layers. Linear mixed effects and mixed-effects Cox proportional hazards models were used to identify clinical and anatomic predictors of vision change and time to surgery.
Results
At presentation, mean BCVA was 0.17 ± 0.10 logMAR units (Snellen 20/30) and mean CMT was 353.3 ± 75.4 μm. After a median follow-up of 3.7 years (range 1–7 years), BCVA declined slowly at 0.012 ± 0.003 logMAR units/year, with phakic eyes declining more rapidly than pseudophakic eyes (0.019 ± 0.003 vs. 0.010 ± 0.004 logMAR units/year). Metamorphopsia, phakic lens status, lamellar hole, and inner nuclear layer cysts were associated with faster visual decline. Cumulative rates of progression to surgery were 2.9, 5.6, 12.2, and 21.1% at years 1–4. Visual symptoms, metamorphopsia, greater CMT, and disruption of outer retinal layers were associated with greater hazard for surgery.
Conclusion
Eyes with iERM and visual acuity ≥ 20/40 experience slow visual decline, with 21% of eyes requiring surgery after 4 years. Clinical and anatomic predictors of vision loss may be distinct from factors associated with earlier surgical intervention.
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Acknowledgements
KYL: none, Tynisha Koenigsaecker: none, AY: none, LM: none, BDJ: NIH UL1 TR001860 (National Center for Advancing Translational Sciences), LSM: none, AM: NIH K08 EY027463, Research to Prevent Blindness, International Retinal Research Foundation, SSP: none, GY: NIH K08 EY026101, E Matilda Ziegler Foundation for the Blind, ARVO Foundation, Alcon Research Institute, California National Primate Research Center, CITRIS/Banatao Institute
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Lawrence S. Morse: consultancy fees from Genentech. Glenn Yiu: grants from Alcon, Genentech, Iridex; and consultancy fees from Alimera, Allergan, Carl Zeiss Meditec, Iridex, and Southern California Desert Retina. The remaining authors declare that they have no conflict of interest.
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Luu, KY., Koenigsaecker, T., Yazdanyar, A. et al. Long-term natural history of idiopathic epiretinal membranes with good visual acuity. Eye 33, 714–723 (2019). https://doi.org/10.1038/s41433-019-0397-z
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DOI: https://doi.org/10.1038/s41433-019-0397-z
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