How is the retina like tissue paper?
The retina is the light-sensitive layer at the back of your eye. Its central area, the macula, gives you the fine detail needed for reading and recognising faces.
Imagine a perfectly smooth piece of delicate tissue paper. An epiretinal membrane is a thin layer of tissue that grows on the retina’s surface. As it contracts, it pulls the retina into small folds, rather like scrunching up that paper.
The underlying retinal cells are shifted out of their usual arrangement. Straight lines can then appear bent or wavy, and letters may look uneven. This distortion is called metamorphopsia. The article on what causes an epiretinal membrane explains how the membrane develops.
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Why can wrinkles remain after epiretinal membrane peeling?
Peeling away the membrane releases its pulling force and allows the retina to relax. Now imagine carefully unfolding the scrunched tissue paper and smoothing it out. It looks much flatter, but fine creases remain; it is difficult to make it exactly as smooth as before.
The retina can behave similarly. Its shape and cell arrangement may improve without returning completely to normal. Some cells may also have been affected by the earlier stretching. The analogy helps explain why vision can improve substantially while a little waviness remains.
Our guide to membrane surgery or observation discusses the benefits and limitations of treatment.
Does the same idea apply to macular hole surgery?
Yes, although a macular hole is a different problem: there is a small opening in the centre of the retina, rather than simply a surface wrinkle.
Surgery releases traction and helps the hole close. However, closing the opening does not instantly restore the surrounding tissue to its original arrangement. The central light-sensitive cells may still be recovering, and some may not recover fully. Subtle changes in their position and structure can leave distortion even when an OCT scan confirms that the hole has closed.
Will the distortion keep improving?
It may. Improvement often continues over several months; after membrane surgery, some improvement can continue for a year. The amount of recovery varies with the changes present before surgery and the condition of the retinal cells. Some distortion can remain in the longer term.
Persistent, stable waviness does not by itself mean that surgery has failed.
Sources
- American Society of Retina Specialists. Epiretinal membranes.
- American Society of Retina Specialists. Macular hole.
- Watanabe A et al. One-year outcomes of metamorphopsia and retinal displacement after epiretinal membrane surgery. Retina. 2022;42:1756–1761.
- Kinoshita T et al. Two-year results of metamorphopsia, visual acuity, and OCT parameters after epiretinal membrane surgery. Graefes Arch Clin Exp Ophthalmol. 2016;254:1041–1049.
- Tsukahara S et al. Retinal displacement and metamorphopsia in eyes undergoing macular hole surgery. Jpn J Ophthalmol. 2025;69:395–402.
- Tsukahara S et al. Correction to the above study: Table 1 labels. Jpn J Ophthalmol. 2025;69:833–834.
- NHS. Detached retina: symptoms and urgent advice.