Vitreoretinal Interface Abnormalities including Vitreo-Macular Traction

What is the vitreous and macula?

ANATOMY.jpgThe eye works like a camera. The lens system in the front of the eye (cornea, pupil, and lens) focuses light onto the back of the eye, the retina. The middle of the eye is filled with a clear, jelly-like substance called vitreous. The vitreous and retina are normally in contact with each other. The retina is the inner lining of the eye and works like the film in a camera; it senses light and allows you to see by transmitting this information to your brain where it is interpreted as images. The macula is the central area of the retina and is the only area that can see fine details. Damage to the macula can severely affect your central vision and make it difficult to perform certain activities such as reading fine print, recognizing faces, or threading a needle.

What is Vitreo-Macular Traction?

Normally the vitreous and retina are in contact with each other. However, over time, the vitreous gel liquefies and separates from the center of the retina in the macula. This is a completely normal process called posterior vitreous detachment (PVD). In most people the vitreous separates completely from the macula with no difficulty. However in some cases the vitreous is so tightly adherent to the macular region that it is still partially attached to it. This incomplete separation can lead to tugging on the retina. Sometimes the tugging is so severe that it can alter the anatomy of the macula and contribute to blurry or distorted vision.

What are the symptoms of Vitreo-Macular Traction?

  • Blurry central vision
  • Distorted or “wavy” vision
  • Gray or blurred spot in central vision
  • Difficulty reading or performing tasks that require detailed vision

What eye conditions are associated with a Vitreo-Macular Traction?

  • Cystoid macular edema
  • Epiretinal membrane
  • Macular hole

How is Vitreo-Macular Traction treated?

For mild symptoms, vitreoretinal interface disorders can be observed and no treatment may be necessary. Keeping your eyeglass prescription updated can help maximize vision. In these milder cases the vitreous may separate on its own over time and the traction resolves spontaneously. For more symptomatic or advanced cases there are two options. The first is a nonsurgical treatment that involves injection of a medication called ocriplasmin (Jetrea), an FDA approved medication. Jetrea works by helping create a complete posterior vitreous detachment thereby relieving the tugging at the macula. In those cases in which Jetrea does not relieve traction the alternative option is pars plana vitrectomy. In this surgical procedure the vitreous is gently removed or peeled from the macula thereby relieving traction. Patients generally have very good anatomical and visual outcome after surgery.