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Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study
  1. Ning Cheung1,2,
  2. Shu-Pei Tan1,
  3. Shu Yen Lee1,
  4. Gemmy Chui Ming Cheung1,
  5. Gavin Tan1,
  6. Neelam Kumar3,
  7. Ching-Yu Cheng1,2,
  8. Tien Yin Wong1,2
  1. 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  2. 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
  3. 3Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
  1. Correspondence to Dr Ning Cheung, Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore; dannycheung{at}hotmail.com

Abstract

Aim To examine prevalence and risk factors of epiretinal membrane (ERM) in a large, contemporary, multiethnic Asian population.

Methods Combined analysis of three population-based studies of eye diseases, with a total of 9799 Chinese, Malays and Indians residing in the general communities of Singapore. A comprehensive ophthalmic examination, interviews and laboratory blood tests were performed to assess potential risk factors. Digital retinal photographs were used to assess ERM according to a standardised protocol. ERM was classified into cellophane macular reflex (CMR) and/or preretinal macular fibrosis (PMF), and also as primary or secondary (in eyes with other retinal pathology or a history of cataract surgery).

Results The age-standardised and ethnicity-standardised prevalence was 12.1% for any ERM, 6.8% for CMR, 6.7% for PMF and 2.8% for bilateral ERM. ERM prevalence was higher in Chinese (13.0%) compared with Malays (7.9%) or Indians (8.7%). In multivariate analysis, significant factors associated with primary ERM were older age (OR 1.08 per year increase; p<0.01), Chinese ethnicity (OR 1.60 vs Indians; p<0.01; OR 1.39 vs Malays; p<0.01), smoking (OR 0.70; p=0.01), longer axial length (OR 1.07 per mm increase; p=0.03) and cataract (OR 0.64; p<0.01). Significant factors independently associated with secondary ERM were older age (OR 1.05; p<0.01), cataract surgery (OR 10.6; p<0.01) and diabetic retinopathy (OR 2.48; p<0.01).

Conclusions ERM is common in Asians, particularly among Chinese. Older age is the most consistent risk factor for any ERM, and previous cataract surgery and diabetic retinopathy are the strongest risk factors for secondary ERM.

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Footnotes

  • Contributors NC contributed to the analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. S-PT contributed to the analysis and interpretation of data for the work, final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SYL, GCMC and GT contributed to drafting the work and revising it critically for important intellectual content, and final approval of the version to be published. NK and C-YC contributed to design of the work, acquisition and interpretation of data for the work, drafting the work and revising it critically for important intellectual content and final approval of the version to be published. TYW contributed to the conception and design of the work, acquisition and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported by the National Medical Research Council grant nos. 0796/2003, 0863/2004 and CSI/0002/2005, and Biomedical Research Council grant no. 501/1/25-5.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval SingHealth Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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