Vitreomacular traction

Vitreomacular Traction

Vitreomacular traction may be a relatively rare condition, but the symptoms it causes can be very frustrating if you are a sufferer.

Some patients experience virtually no effect on their eyesight, while others report substantial changes to their vision. Age is the biggest causal factor in vitreomacular traction. As we get older, the clear gel inside our eyes (the vitreous) begins to shrink and pull away from the retina at the back of our eyes. This tension can lead to distortion in the central part of our vision. Opting to have surgery for vitreomacular traction is very much a case-by-case decision. As we analyse your eyes, we will be able to give you the right information you need to make the choice.

The main hollow area of the eye, behind our lens, is filled with a material called vitreous gel. As we age this clear, jelly-like substance opacifies (becomes opaque) and shrinks away from the retina. This is a very common occurrence, affecting about 75% of people over the age of 65. Separation of the vitreous gel from the retina is known as posterior vitreous detachment, or PVD. It does not itself cause any permanent loss of vision, though floaters may be troublesome.

In vitreomacular traction, however, the separating vitreous jelly pulls on the central macular area of the retina, at the back of the eye. This can cause impairment to your central vision, either in the form of a generalised blurring, or with distortion.

In rare cases the shrinkage of the vitreous jelly within the eye results in a partial separation, where some jelly remains attached to the very central macular area of the retina. What causes this to happen is unknown and it’s only in the last few years, with the arrival of Optical Coherence Tomography (OCT) retinal scanning, that we have been able to recognise this appearance.

An alternative to surgery is the injection of Ocriplasmin. This is an enzyme which breaks down the vitreous gel and can speed separation from the macula in some cases. However, a number of side effects have been reported and many patients still require surgery. This treatment has not, as yet, proved popular in the UK.

Example of vision with floaters.

As we get older, the vitreous gel inside our eyes naturally shrinks. This can ultimately lead it to separate from the retina. There are certain points on the retina, however, where the vitreous jelly can be unusually adherent. One of these is in the very central macular area.

The retina is multi-layered and ongoing traction (“pulling”) from the jelly can cause the macular area to swell as the retinal layers separate. The inner layers are pulled inwards towards the vitreous cavity (the main interior part of the eye), while the outer layers remain adherent to the eye wall. The situation worsens as normal eye movements cause the jelly within the eye to rotate. This movement produces a relentless pull on the macula.

OCT image showing vitreomacular traction with “pull” and swelling of the macular area.

Common symptoms of vitreomacular traction are:

  • the appearance of a blurred patch in the central vision.
  • distortion of straight lines, which appear broken or bent.
  • a loss of contrast sensitivity – “greying” of central vision.
  • loss of colour vision.

Treatment for vitreomacular traction involves removing the vitreous jelly inside the eye, which is carried out with a vitrectomy operation.

The purpose of surgery is to separate the vitreous gel from the underlying macula, so that the retinal layers can return to a more normal position. Doing this will give you every chance of avoiding further visual loss, and in most cases a degree of visual improvement is possible.

Since vitreomacular traction is potentially progressive, early surgery offers the best chance of long-term visual success. But even if you are experiencing only a few symptoms, we may still recommend surgery to prevent further worsening. When you come in to the clinic, we will be able to help you decide if vitrectomy surgery for vitreomacular traction is appropriate for you.

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