Vitreomacular Traction

The retina is the inside lining of the back of the eye. It is composed of many layers of light sensitive nerve cells. Light entering the eye is focused on the retina and is converted to electrical impulses which are carried to the brain by the optic nerve. The centre of the retina is called the macula. It is the most sensitive part of the retina and is used for day light and colour vision. This is in contrast to the rest of the retina which is more sensitive in the dark and is mainly used for navigational black and white vision at night.

The retina is supplied by one main artery and one main vein which enter through the optic nerve and branch all over the retina to smaller arteries and veins that cross each other like railway tracks.

source – American Academy Ophthalmology

The cavity of the eye is naturally filled with gel like clear material called the vitreous. It is adherent to the inner surface of the retina. With ageing or in certain eye condition, the vitreous loses its normal consistency and separates itself from the retina in a process called posterior hyaloid detachment (PVD). If the vitreous detachment is complete, the patient will notice moving spots or lines across the vision called floaters.

If the posterior hyaloid detachment process is incomplete, some vitreous will remain attached to the retinal surface causing pulling or traction on it. If the traction is at the macula the condition is called vitreomacular traction (VMT).

  • Older patients
  • Females
  • High myopia (short-sightedness)
  • Age related macular degeneration
  • Diabetic retinopathy
  • Retinal vein occlusion
  • Blurred vision
  • Flashes of light (photopsia)
  • Distortion of image (metamorphopsia)
  • Change in image size; smaller (micropsia) or larger (macroposia)
  • Dilated retina examination: This is the standard test to check the back of your eye (retina). You will have your pupil dilated with drops so your vision will be blurry for an hour or two after the examination. Our specialist will check your eyes on the microscope (slit lamp) and uses a special lens to see the details of the retina. The peripheral retina will be checked with another instrument called an indirect ophthalmoscope. You will also receive a full examination of your eyes including the front of the eye (anterior segment).
  • OCT (optical coherence tomography); this is a fast scan of the retina centre (macula) which shows cross section details of its layers. In vitreomacular traction, the back surface of the vitreous will be shown as a line pulling on the macula and lifting it up.

OCT of vitreomacular traction

  • Observation: if the condition is causing minimal complaint, patients will be observed every few months. In some cases the traction will resolve spontaneously.
  • Vitrectomy surgery: after removal of the core vitreous gel, the vitreous adherent to the macula is carefully released.
  • Ocriplasmin (Jetrea): this is a new engineered drug related to plasmin. It acts on the vitreous gel causing it to release its traction from the retina.

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