Macular pigment optical density (MPOD) in eyes with primary epiretinal membrane (ERM) is associated with central foveal thickness (CFT) and outer nuclear layer thickness (ONLT), according to research published in Retina.

Foveal macular pigment (MP) can protect against age-related macular degeneration (AMD), according to the research team. However, few studies show how vitreo-macular interface pathologies influence MPOD. 

The researchers assessed 62 individuals with unilateral primary ERM (35 women, mean age 62.5±9.1 years), divided into 4 stages based on optical coherence tomography (OCT) findings (13 eyes were in Stage 1, 27 were in Stage 2, 16 were in Stage 3, and 6 were in Stage 4). Ten eyes had experienced outer retinal bands (ORB) disruption, and 13 had central bouquet (CB) abnormalities (8 cotton ball sign, 3 acquired vitelliform lesion, 2 foveolar detachment).

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The team found eyes with ERM tend to have higher mean MPOD compared with healthy eyes (0.86±0.07 vs 0.48±0.09, P <.001). Mean BCVA was 0.37±0.2 logMAR in eyes with ERM and 0 in the healthy eyes, and better among eyes in stages 1 and 2 compared with later stages (P <.001).

MPOD increased in later stages of ERMs and was higher among eyes with ERM compared with healthy eyes. MPOD, BCVA, and MPOD were associated with CFT, and outer retinal alterations were linked with BCVA.

Disruption of ORBs are more likely to occur in eyes with lower BCVA, the study suggests. Eyes with cotton ball sign tend to have better visual acuities compared with eyes with acquired vitelliform lesions. The researchers also show a link between MPOD and BCVA.

“We observed an increased MPOD in eyes affected by primary ERM and higher values were found in advanced stages, while both ORB and CB abnormalities did not affect MPOD. Probably, centripetal forces exerted by ERM contraction on the retinal surface lead to a progressive foveal packing of the MCC, that is the site where MP is mostly located,” according to researchers. “In fact, CFT and, especially, ONLT resulted in direct proportion to MPOD suggesting that ONL thickening in part is due to MCC central shift. Since MPOD resulted strongly related to ERM severity, its measurement could become part of the pre-operative assessment of eyes affected by primary ERM.”


Cerino L, Aharrh-Gnama A, Ludovica M, et al. Macular pigment optical density assessed by heterochromatic flicker photometry in eyes affected by primary epiretinal membrane. Retina. Published online December 10, 2021. doi:10.1097/IAE.0000000000003387