Epiretinal membrane (ERM) is a fibrocellular tissue proliferation on the inner limiting membrane (ILM) leading to various changes in the retinal architecture. In this study, Sakimoto et al. reported that ERM can be a potential risk factor for unilateral severity in eyes with POAG. The proposed mechanism is mechanical stress and vascular insult to the inner retina induced by the ERM leading to thinning of the retinal nerve fiber layer (RNFL) and subsequent glaucomatous damage.
While this is an interesting theory, it needs to be confirmed by longitudinal studies investigating the temporal relationship between the ERM and RNFL change. In a recent study,1 RNFL was found to be thickened after the development of ERM. However, it is possible that although RNFL was thickened right after the development of an ERM, and persistent mechanical and vascular insult on the inner retinae results in eventual thinning of the RNFL. 2,3 Whether or not persistent traction from an ERM accelerates glaucomatous damage of retinal ganglion cell axons remains to be elucidated. As well, it may be helpful to assess the changes in the superficial retinal layer microvasculature in glaucomatous eyes with ERM by using optical coherence tomography angiography (OCT-A).
Nevertheless, the results of this study represent a good start in understanding the influence of ERM on the glaucomatous optic neuropathy. Further prospective longitudinal studies examining the RNFL changes before and after the development of the ERM in glaucoma patients are warranted.