AAO 2024: Epimacular membranes and metamorphopsia

At this year's American Academy of Ophthalmology (AAO) meeting, Jonathan Brugger, MD, spoke about the changing approach to epimacular membranes and the use of brilliant blue in the procedure.

Editor's note: This transcript has been lightly edited for clarity.

Jonathan Brugger, MD: I'm Dr Jonathan Brugger. I'm a vitreoretinal surgeon with Carolina Eye Care in Charleston, South Carolina. And I wanted to shed some light on epimacular membranes. A lot of the teaching that we have been taught in generations was that "we don't want to touch epimacular membranes until they are visually significant."

However, with safer procedures, better instruments, and now non-toxic, brilliant blue, we should be having earlier intervention on epimacular membranes, to the point that surgeons now are approaching patients that are symptomatic with metamorphopsia to peel even [a] 20/20 vision eye. That's simply because individuals can see that it's the letter T, whether it's perfectly straight or if it's slightly twisted, but the patients now that we are peeling early, have quicker resolution of their metamorphopsia and report that the vision is actually better, that the T is straight, if you will, and we have not caused any harm to the retina. With the non-toxic brilliant blue, we feel confident that we're getting all of the membrane because we're able to re-stain multiple times.

The adage of "waiting until the membrane gets bad enough," you will be sitting there for a lifetime, because we do know that a majority of these membranes will form and then they do not progress. So you will be watching these patients for years and years and years that are symptomatic but not getting better. And now, I think the time has come that we should start looking at this again for early intervention of peeling symptomatic epimacular membranes.