The authors present the findings of a retrospective study to correlate metamorphopsia and ectopic inner foveal layers (EIFL) or ‘central bouquet’ abnormality (CBA) in patients with advanced stages of epiretinal membrane (ERM) following the new OCT‐based grading scheme as described by Govetto et al. They recruited a cohort of 57 (32 female, 25 male) patients of which 60 eyes were affected by advanced idiopathic ERM (stages 3 and 4) with best corrected visual acuity (BCVA) ≥ 20/100. The degree of metamorphopsia was assessed by the M‐CHARTs and documented as a vertical (M-V), horizontal (M-H) and a mean M score. Retinal images were obtained using the Spectral Domain (SD)‐OCT. Staging of advanced ERMs (stages 3 and 4) was applied using the novel OCT‐based grading system. Three patients had bilateral ERMs, while 54 patients with unilateral ERM had normal foveal contour in the fellow eye. Mean M‐SCORE exhibited a statistically significant correlation with EIFL and central foveal thickness (CFT) (both p<0.0001), but not with CBA (p=0.84). The differences were not significant for both M‐V and M‐H regarding CBA presence. Using the novel OCT‐based grading scheme for ERMs, the authors conclude that EIFL, but not CBA, can possibly be considered a reliable indicator for metamorphopsia in patients with advanced ERMs. This study is limited by its retrospective nature, the lack of early stages of ERM and the lack of a follow‐up period.