HomeHealth articlesposterior vitreous detachmentWhat Is Vitreomacular Traction?

Vitreomacular Traction - Causes, Symptoms, Diagnosis, Treatment, and Complications

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Vitreomacular traction is a disorder wherein a part of the vitreous remains attached to the macula during a posterior vitreous detachment.

Written by

Dr. Sumithra. S

Medically reviewed by

Dr. Shachi Dwivedi

Published At October 19, 2022
Reviewed AtFebruary 29, 2024

Introduction

The eye undergoes many changes as a person ages, resulting in various conditions causing vision problems. One such condition is vitreomacular traction. The middle region of the eye (the space between the lens and the retina) is filled with a clear gel called the vitreous humor. The retinal layer is essential for vision since it transmits signals to the brain to form an image. The center part of the retina is known as the macula.

The vitreous humor is attached to the retina normally. As a person grows older, the vitreous humor shrinks and tends to detach from the retina causing posterior vitreous detachment, and this condition will not cause vision problems and does not require treatment mostly. In some cases, the vitreous will not detach completely and it will remain attached to the macula. This condition is called vitreomacular traction. If this condition is left untreated, it may cause serious vision changes.

The incidence of vitreomacular traction is common in both males and females but it is slightly higher in women in the post-menopausal phase since the decreased estrogen levels tend to change the gel-like vitreous to a liquid state much earlier.

What Is the Pathophysiology of Vitreomacular Traction

Some changes are noted in the vitreous gel with aging. For example, the vitreous gel dissolves and forms fluid pockets resulting in the condensation or contraction of the vitreous. As a result, a tractional pull is observed at the vitreoretinal and vitreopapillary attachments due to the loss of vitreous volume. Simultaneously, the attachments between the internal limiting membrane and the vitreous weaken. It has been noted that the posterior hyaloid process detachment progress in the following sequence:

  • Perifoveal region (part of the retina that circumscribes the parafovea and the fovea).
  • Superior and inferior vascular arcades.
  • Fovea.
  • Mid-peripheral retina.
  • Optic disc.

Posterior vitreous detachment occurs when the vitreous pull and the weakening of the retinal attachments co-occur. However, the problem arises when these changes occur uncoordinatedly, resulting in the development of an abnormal posterior vitreous detachment or vitreomacular traction.

What Are the Causes of Vitreomacular Traction?

The main causative factor is believed to be aging. As a person ages, the vitreous humor becomes liquid-like (normally a gel-like substance), and it tries to detach from the retinal layer causing posterior vitreous detachment. Sometimes it will still be attached to the macula and cause vitreomacular traction.

Few medical conditions have also been found to increase the chances of vitreomacular traction and they are,

  • High Myopia - It is a rare condition where extreme nearsightedness is present. Nearsightedness (myopia) means a person will only be able to see nearby objects and the farther away remain blurred. It is caused by the elongated eyeball.

  • Diabetic Macular Edema - Accumulation of fluids in the central compartment of the retinal layer - macula causes swelling (edema).

  • Diabetic Retinopathy - Diabetes is found to affect the blood vessels supplying the retinal layer and cause vision problems called diabetic retinopathy.

  • Retinal Vein Occlusion - The vein supplying the retinal layer gets blocked due to underlying conditions like glaucoma, leukemia, and other factors like aging, obesity, and smoking.

  • Macular Degeneration - As a person ages, the macula of the retinal layer undergoes degeneration either by retinal deterioration (dry) or blood vessel leakage over the retinal layer (wet).

What Are the Symptoms of Vitreomacular Traction?

Common symptoms of vitreomacular traction include,

  • Micropsia - The objects will appear smaller than the actual size.

  • A series of straight lines appear wavy or blurry - distorted vision.

  • Flashes of light appear in the path of vision.

  • Scotoma - Presence of a blind spot in the path of vision.

How Is Vitreomacular Traction Classified?

According to the width of the attachment,

  • Focal - This type includes attachments of width less than or equal to 1500 micrometers.

  • Broad - This type includes attachments of a width greater than 1500 micrometers.

According to the presence of other macular abnormalities,

  • Concurrent - Abnormalities like retinal vein occlusion and macular degeneration will be associated with it.

  • Isolated - There will be no associated macular abnormalities.

How to Diagnose Vitreomacular Traction?

In order to arrive at a diagnosis, the ophthalmologist will suggest the patient go through a few tests.

  • Optical Coherence Tomography (OCT) - It is the most preferred test used to diagnose vitreomacular traction and it helps to see the damage in the macular surface precisely. This test uses light waves to take pictures of the retinal surface and then it is studied.

  • Fundus Fluorescein Angiography (FFA) - It is an imaging technique that helps diagnose different retinal diseases. This test also helps determine whether the patient needs laser treatment for the retinal conditions or not. In this procedure, a cannula is attached to the veins in the patient's arm. Next, the doctor obtains a few images of the back of the eye (fundus), followed by the injection of an orange-yellow colored fluorescein dye into the cannula. This dye reaches the eyes through the blood vessels. Finally, the patient is asked to keep his eyes still as the doctor takes several images to capture the movement of the dye. Hence, this test is useful in diagnosing diabetic macular edema, central serous retinopathy, and vitreomacular traction and provides minute details regarding the retina's blood supply.

What Are the Possible Differential Diagnoses of Vitreomacular Traction?

  • Full-thickness macular hole in the early stages.

  • Cystoid Macular Edema - A cyst-like fluid area, found on the macular surface causing swelling. It is a painless condition.

  • Epiretinal Membrane - A sheet-like structure forms over the retinal surface naturally. When the sheet starts to shrink, vision will be greatly affected as the retinal surface also starts wrinkling.

How to Treat Vitreomacular Degeneration?

  • Wait and See Approach - If the vitreomacular traction diagnosed is mild, doctors will recommend observing the case, as these mild cases can resolve by themselves. During this period, doctors will train the patient to use the Amsler grid to keep the condition in check.

  • Surgical Approach - In case of complications like macular holes or cystoid macular edema, surgery is suggested.

A surgical procedure called vitrectomy will be done. The vitreous part of the eye will be removed and replaced with saline. The scar tissue on the macular surface causing the traction will be removed using a special instrument. This procedure’s goal is to restore the flat surface of the macula.

The possible complications of vitrectomy done to treat vitreomacular traction,

  1. Cataract - The otherwise healthy and clear lens of the eye will become fogged and cause vision changes called cataract.

  2. Retinal Detachment - The retinal layer will detach from the back of the eyes and lose nourishment from the blood vessels. Thus, the vision field will be affected.

  3. Glaucoma - The optic nerve essential for vision will be affected.

  4. Endophthalmitis - The vitreous humor part of the eye will be affected by bacterial or viral infection.

  5. Retinal Pigment Epithelium Damage.

  • Medications - In cases where the patient is not eligible for a surgical procedure, the doctor would recommend medicines to treat the vitreomacular traction. Injecting ocriplasmin into the central part of the eye to dissolve the protein fibers connecting the vitreous and macula.

What Are the Possible Complications of Vitreomacular Traction?

  • Full Thickness Macular Hole - A hole forms in the central part of the retina - macula. It affects central vision.

  • Macular Detachment.

  • Tractional Macular Schisis.

Conclusion

The condition of vitreomacular traction is majorly age-related. Ample medical resources are available to treat the condition. Consulting with an ophthalmologist as soon as the first sign is seen, will help avoid a lot of complications.

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Dr. Shachi Dwivedi
Dr. Shachi Dwivedi

Ophthalmology (Eye Care)

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vitreomacular tractionposterior vitreous detachment
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