What is the vitreomacular traction syndrome?
The vitreomacular traction syndrome is a condition in which the vitreous gel, which fills the inside of the eye, pulls on the macula. The macula is the center of the retina and gives sharp central vision for reading and seeing fine details. The retina is a thin layer of tissue in the back of the eye that lines the inside wall like the film inside the back of a camera. The retina “takes a picture” of objects you look at and sends it to the brain. When the macula is damaged, the central vision worsens.
What causes the vitreomacular traction syndrome?
The vitreomacular traction is caused when the clear gel that fills the eye (vitreous) pulls on the macula. At birth the vitreous is a thick and perfectly clear gel. With age or trauma the vitreous gel begins to condense and pull away from the retina. If the attachment of the vitreous to the macula is unusually strong, the vitreous may pull the macula away from its normal position, distorting this normally smooth tissue.
What are the symptoms of the vitreomacular traction syndrome?
Blurring of vision is mild at first, noted especially while trying to read fine print. It slowly worsens, often with distortion (straight lines look crooked). Sometimes there is a vague blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.
What treatment is available?
If the symptoms are mild, no treatment is needed. Medicine injection (Jetrea®) or vitrectomy surgery may help if there is significant loss of vision. In most cases the vision improves with injection or a surgery that releases the abnormal pulling of the vitreous on the macula. A gas bubble may be placed in the eye to smooth out the macula. Strict facedown positioning may be recommended for one week following surgery. Special cushions and massage tables are available to help maintain the proper head position. The surgery is usually successful in returning vision, though the vision may not return completely to normal.
The image below shows the separation of vitreous fibers from the macula after Jetrea injection:
Below is a video that reviews the anatomy of the eye, information on vitreomacular traction, and an example of vitrectomy surgery:
https://youtu.be/r-5Az8_DU3U
Below is the case of a 70-year-old woman who had mild VMT. She was observed over several years and the traction released without surgery.
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