Japanese Journal of Ophthalmology

, Volume 62, Issue 3, pp 280–285 | Cite as

Comparison of visual acuity, metamorphopsia, and aniseikonia in patients with an idiopathic epiretinal membrane

  • Atsuhiro Tanikawa
  • Yoshiaki Shimada
  • Masayuki Horiguchi
Clinical Investigation



The clinical course of reduced visual acuity, metamorphopsia, and aniseikonia are dissimilar in patients with an epiretinal membrane (ERM). We measured and compared the best-corrected visual acuity (BCVA), metamorphopsia, and aniseikonia of patients with ERM.


We measured metamorphopsia and aniseikonia horizontally as well as vertically with the M-CHART (MH and MV) and New Aniseikonia Test (NATH and NATV) in 61 patients with unilateral idiopathic ERM. We compared the BCVA with the other values. Comparisons between the MH and the NATV and between the MV and the NATH were performed, because the MH assesses vertical metamorphopsia, and the MV, horizontal metamorphopsia.


BCVA was not significantly correlated with the other values (MH vs BCVA: P = .69; MV vs BCVA: P = .114; NATH vs BCVA: P = .656; NATV vs BCVA: P = .935). The MH and NATV magnitudes were significantly correlated, but the correlation coefficient was small (P = .007, r = 0.343); no significant correlation was found between the MV and NATH magnitudes (P = .065). We found patients with aniseikonia, but no metamorphopsia (n = 6), and more patients with metamorphopsia, but no aniseikonia (n = 11). Only 23 patients had coincident directions of metamorphopsia and aniseikonia.


The magnitudes of metamorphopsia and aniseikonia were not closely correlated and their directions did not coincide in most patients. Neither the M-CHARTS nor the NAT measurements correlated with the BCVA. Quantitative testing of metamorphopsia and aniseikonia in addition to that for BCVA is necessary to assess visual function in patients with ERM.


Aniseikonia Epiretinal membrane Metamorphopsia Retina Visual acuity 




Conflicts of interest

A. Tanikawa, None; Y. Shimada, None; M. Horiguchi, None.


  1. 1.
    Matsumoto C, Arimura E, Okuyama S, Takada S, Hashimoto S, Shimomura Y. Quantification of metamorphopsia in patients with epiretinal membranes. Invest Ophthalmol Vis Sci. 2003;44:4012–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Kinoshita T, Imaizumi H, Okushiba U, Miyamoto H, Ogino T, Mitamura Y. Time course of changes in metamorphopsia, visual acuity, and OCT parameters after successful epiretinal membrane surgery. Invest Ophthalmol Vis Sci. 2012;53:3592–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Tachibana T, Yoshida S, Kobayashi Y, Nakama T, Ishikawa K, Sengoku A, et al. Differential improvement of vertical and horizontal metamorphopsia scores after epiretinal membrane vitrectomy with ILM peeling. Acta Ophthalmol. 2015;93(8):e681–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Nomoto H, Matsumoto C, Arimura E, Okuyama S, Takada S, Hashimoto S, et al. Quantification of changes in retinal contraction in eyes with spontaneous separation of idiopathic epiretinal membrane. Eye. 2013;27:924–30.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Okamoto F, Sugiura Y, Okamoto Y, Hiraoka T, Oshika T. Associations between metamorphopsia and foveal microstructure in patients with epiretinal membrane. Invest Ophthalmol Vis Sci. 2012;53:6770–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Watanabe A, Arimoto S, Nishi O. Correlation between metamorphopsia and epiretinal membrane optical coherence tomography findings. Opthalmology. 2009;116:1788–93.CrossRefGoogle Scholar
  7. 7.
    Okamoto F, Sugiura Y, Okamoto Y, Hiraoka T, Oshika T. Inner nuclear layer thickness as a prognostic factor for metamorphopsia after epiretinal membrane surgery. Retina. 2015;10:2107–14.CrossRefGoogle Scholar
  8. 8.
    Awaya S, Sugawara M, Horibe F, Torii F. The, “new aniseikonia tests” and its clinical applications [in Japanese]. Nippon Ganka Gakkai Zasshi. 1982;86:217–22.PubMedGoogle Scholar
  9. 9.
    Hisada H, Awaya S. Aniseikonia of central serous chorioretinopathy [in Japanese]. Nippon Ganka Gakkai Zasshi. 1992;96:369–74.PubMedGoogle Scholar
  10. 10.
    Ugarte M, Williamson TH. Aniseikonia associated with epiretinal membrane. Br J Ophthalmol. 2005;89:1576–80.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    De Wit GC. Retinally-induced aniseikonia. Binocul Vis Strabismus Q. 2007;22:96–101.PubMedGoogle Scholar
  12. 12.
    Okamoto F, Sugiura Y, Okamoto Y, Hiroaka T, Oshika T. The time course of changes in aniseikonia and foveal microstructure after vitrectomy for epiretinal membrane. Ophthalmology. 2014;121:2255–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Enoch JM, Schwartz A, Chang D, Hirose H. Aniseikonia, metamorphopsia and perceived entoptic pattern: some effects of a macular epiretinal membrane, and the subsequent spontaneous separation of the membrane. Ophthalmic Physiol Opt. 1995;4:339–43.CrossRefGoogle Scholar
  14. 14.
    De Wit GC, Muraki CS. Field-dependent aniseikonia associated with epiretinal membrane: a case study. Ophthalmology. 2006;113:58–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Benegas NM, Egbert J, Engel WK, Kushner BJ. Diplopia secondary to aniseikonia associated with macular disease. Arch Ophthalmol. 1999;117:896–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Michels RG. Vitrectomy for macular pucker. Ophthalmology. 1984;91:1384–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Michels RG. A clinical and histopathologic study of epiretinal membranes affecting the macula and removed by vitreous surgery. Trans Am Ophthalmol Soc. 1982;80:580–656.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Tanikawa A, Horiguchi M, Kondo M, Suzuki S, Terasaki H, Miyake Y. Abnormal focal macular electroretinograms in eyes with idiopathic epimacular membrane. Am J Ophthalmol. 1999;127:559–64.CrossRefPubMedGoogle Scholar
  19. 19.
    Hosoda Y, Ooto S, Hangai M, Oishi A, Yoshimura N. Foveal photoreceptor deformation as a significant predictor of postoperative visual outcome in idiopathic epiretinal membrane surgery. Invest Ophthalmol Vis Sci. 2015;56:6387–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Watanabe A, Arimoto S, Nishi O. Correlation between metamorphopsia and epiretinal membrane optical coherence tomography findings. Ophthalmology. 2009;116:1788–93.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2018

Authors and Affiliations

  • Atsuhiro Tanikawa
    • 1
  • Yoshiaki Shimada
    • 1
  • Masayuki Horiguchi
    • 1
  1. 1.Department of OphthalmologyFujita Health University School of MedicineToyoakeJapan

Personalised recommendations