Answered by: Dr. Anne Berenbom

From the information you’ve provided, it sounds like you have what is called an epiretinal membrane, which is a very thin layer of scar tissue overlying the macula, or central area of the retina responsible for central vision. The membrane sits on the macula like a piece of cellophane, The membrane tugs on and distorts the macula, causing distortion and blurring of vision. No one knows exactly what causes epiretinal membranes and they are not necessarily related to diabetes. In fact, at autopsy, epiretinal membranes are found in 20% of patients over age 75. 

The only way to get rid of an epiretinal membrane is by surgical removal.  A pars plana vitrectomy is performed, meaning the jelly (vitreous) overlying the retina is removed, and then the membrane is carefully peeled off of the macula.  Patients see an improvement in vision in 50-75% of cases, but very few patients return to normal vision.  Surgery is usually reserved for patients with vision of 20/60 or worse, but this can vary from surgeon to surgeon.  On the other hand, patients who do not undergo surgery usually remain stable and do not suffer from further worsening of vision.  Any eye surgery carries risks, including infection or bleeding.  This particular surgery carries a risk of creating a retinal hole or tear, which would require more extensive surgery to repair.  But the bottom line is that surgery is not a guaranteed fix and that vision is very likely to remain stable with no intervention. 

It is wonderful that your sugars are now controlled and that you no longer require insulin.  However, that does not have any impact on your epiretinal membrane. It is difficult to give you exact answers to your questions without examining you myself.  My advice is to discuss this matter with your retina specialist and also to consider getting a second opinion.  At the very least, you will have the peace of mind that you have done everything you can to try to improve your vision.

Answered by: Dr. Anne Berenbom

The best way to prevent and control diabetic retinopathy is to maintain good blood sugar and blood pressure control.  Unfortunately, getting your sugars under control does not have an immediate effect on diabetic retinopathy.  The retinopathy tends to lag behind your sugars by several years.  Taking good care of your sugars now will help prevent the retinopathy from progressing in the years to come and may even lead to a resolution of the retinopathy.  Right now, it is essential that you see a retina specialist to assess whether you need laser treatment to prevent progression of retinopathy in the near future.  Good blood pressure and blood sugar control and yearly dilated exams are essential to every diabetic’s eyes.