Vitreomacular traction

The eye is filled with the so-called vitreous, a transparent gel-like substance. In young and healthy people, the vitreous is firmly attached to the retina and macula by millions of microscopic fibres. With age or as a result of injury, the vitreous shrinks and pulls the retina. Gradually, the vitreous is completely detached from the retina. This is a normal condition called posterior vitreous detachment (PTA) which occurs in most people over the age of 70.

Vitreomacular traction

The eye is filled with the so-called vitreous, a transparent gel-like substance. In young and healthy people, the vitreous is firmly attached to the retina and macula by millions of microscopic fibres. With age or as a result of injury, the vitreous shrinks and pulls the retina. Gradually, the vitreous is completely detached from the retina. This is a normal condition called posterior vitreous detachment (PTA) which occurs in most people over the age of 70.
Sometimes, the vitreous is not completely detached from the retina and remains attached to its central part – the macula. As a result, the vitreous tightens the macula, and this phenomenon is called vitreomacular traction. Without any treatment, this disorder may result in loss of central vision.

What causes vitreomacular traction?

Typically, vitreomacular traction occurs when part of the vitreous does not detach from the retina and remains attached to the macula.
Vitreomacular traction is rare in healthy eyes. Certain eye diseases increase the risk of vitreomacular traction, namely:

  • high myopia (severe myopia)
  • age-related macular degeneration (damage to the central part of the retina)
  • diabetic eye damage (with this disorder, retinal vessels suffer)
  • occlusion of the central retinal vein (overlapping of the vein in the retina).

Terms

Retina is a layer of nerve cells, located on the inner surface of the eye. The retina senses light and sends signals to the brain, with images formed out of these signals in the brain.

Macula is a small but very important area in the centre of the retina. Macula is needed to clearly see the small details of objects.

Vitreous is a transparent gel which fills the eye cavity from the inside, maintains the rounded shape of the eye and transmits light rays to the retina.

The manifestations of vitreomacular traction are similar to manifestations of other eye pathologies, so be sure to consult an ophthalmologist as soon as you notice any symptoms.

What are the symptoms of vitreomacular traction?

The most common symptoms of vitreomacular traction:

  • distorted lines – a grid of straight lines looks distorted or blurry;
  • flashes of light in the field of vision;
  • items appear to be smaller than their actual size.

These symptoms may be indicative of other eye disorders as well. Therefore, if you notice any of these symptoms, be sure to see an ophthalmologist.

How is vitreomacular traction diagnosed?

To diagnose vitreomacular traction, an ophthalmologist is to examine the retina with a special lens, after dilating the pupil with eye drops.
Optical coherence tomography (OCT) – a special light scanner forms an image of all layers of the retina, which shows damage to the macula.

Fluorescence angiography. A yellow dye (fluorescein) is injected into a vein of an arm. Through the blood vessels, the dye enters the retina, and at this time it is photographed with a special camera. Such photograph enables the ophthalmologist to assess the blood circulation in the retina and reveal macular oedema – a common symptom of vitreomacular traction.

Ultrasound examination. Ultrasound helps the ophthalmologist to better examine the junction of the macula and vitreous.

All these examinations will help reveal vitreoretinal traction and, if necessary, prescribe appropriate treatment.

How is vitreoretinal traction treated?

There are three approaches to treating vitreoretinal traction.

Observation or expectant treatment. If vitreoretinal traction does not impair vision, treatment may not be necessary. Sometimes vitreoretinal traction goes away without treatment, therefore, ophthalmologists recommend some patients only regular examinations. In addition, patients need to check their eyesight at home using the Amsler grid on a daily basis. The ophthalmologist will check if you are using the Amsler grid correctly.

Surgery. In severe cases, vitreoretinal traction can threaten the loss of central vision as a result of retinal damage:

  • macular rupture (the vitreous strings up the macula which tears)
  • epiretinal membrane (connective tissue forms in the macula – a scar which distorts vision)
  • cystic macular oedema (accumulation of fluid in the macula).

In such cases, to restore the normal (flat) configuration of the macula, a surgery (vitrectomy) is performed. The surgeon removes the vitreous from the eye cavity, removes scar tissue from the macula, fills the eye cavity with a gas bubble, and, thus, frees the macula from traction.

Summary

Vitreoretinal traction is a consequence of too tight connection of the vitreous to the retina. Therefore, with age, the vitreous does not detach from the macula and tightens it, threatening the loss of central vision. The symptoms of vitreoretinal traction include distorted/blurred vision, flashes in front of the eyes, as well as perception of objects less than their actual size.

Vitreoretinal traction sometimes goes away without treatment. Severe vitreoretinal traction can lead to loss of central vision. In such cases, surgical treatment is performed.

For the detailed information on visual impairment, be sure to contact an ophthalmologist. The doctor will make every effort to protect your vision.

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