Our eyes are filled with a clear, jelly-like substance, known as the vitreous humour, that sits behind the lens at the front of the eye and the retina (the light-sensitive layer) at the back of the eye. Its job is to keep the eye in its spherical shape.
The vitreous is attached to the retina by lots of tiny fibres, but over time, the vitreous starts to shrink and pull away from the retina. This is a normal part of the ageing process that typically happens some time after the age of 50, known as posterior vitreous detachment.
What is vitreomacular traction syndrome?
Sometimes, the vitreous of the eye doesn’t detach itself completely from the retina, and part of it can remain stuck to the macula, found in the middle of the retina — this is vitreomacular traction. ‘Traction’ refers to the process of the vitreous essentially tugging on the macula as it tries to detach itself, which can damage the macula and cause partial vision loss if left untreated.
What are the symptoms of vitreomacular traction?
There are several symptoms of vitreomacular traction syndrome to look out for, including:
- Distorted vision (straight lines can look wavy, bent, blank or blurry)
- The appearance of flashing lights
- Objects looking smaller than their actual size
The symptoms may be mild, develop slowly, and can present independently. For example, you may experience distorted vision but without a reduction in the sharpness of your vision. If you’re experiencing any of these symptoms, book an appointment with an optometrist to have your vision checked as soon as possible.
What causes vitreomacular traction?
Vitreomacular traction syndrome is usually caused by ageing, where the vitreous humour starts to become watery, rather than its usual gel-like substance. Not all cases of posterior vitreous detachment result in this way, but there are some factors that could put you at a higher risk of developing VMT, including:
- Being very short-sighted (high myopia)
- Diabetic retinopathy (damage to the blood vessels that supply the retina)
- Retinal vein occlusion (a blockage in the veins of the retina)
- Age-related macular degeneration (a condition affecting your central vision)
How serious is vitreomacular traction?
If left untreated, vitreomacular traction can also lead to other conditions, such as:
- Retinal tears (a tear in part of the retina)
- Retinal detachment (when the retina separates from the back of the eye)
- Macular pucker (also known as epiretinal membrane, a thickening of the inner layer of the retina)
- Macular hole (when the vitreous tugs enough to form a small hole)
Vitreomacular traction diagnosis
If you are experiencing any symptoms of VMT, make sure to book an appointment so an optometrist can take a look and check for any signs of this condition. The most common form of diagnosis for vitreomacular traction is through optical coherence tomography (OCT).
Can an OCT help diagnose vitreomacular traction?
OCT is a quick, non-invasive scan that can be a useful tool in diagnosing and monitoring vitreomacular traction syndrome. A vitreomacular traction OCT scan can be done during an eye test and uses light waves to create a 3D image of the eye. This allows your optometrist to see the retina and all its layers in great detail, so they can spot signs of anything out of the ordinary.
They’ll also be able to assess how the vitreomacular traction is affecting the retina, in order to make a judgement about possible treatment or onward referral. In some cases, treatment might not be necessary, but monitoring with regular OCT scans may be needed to keep an eye on the health of the retina.
When to book an OCT scan
If you ever have any of the symptoms mentioned here, it’s important that you book an appointment with your optician as soon as possible. If you’re over 25 or have a family history of eye conditions, your optician might recommend that you add an OCT to your routine eye test. Having your images on file helps them to track any potential changes over time, or spot anything suspicious.
Vitreomacular traction treatment
If vision isn’t affected by VMT, treatment might not be needed. Some people will need to come in for regular follow-ups to keep track of any progress.
If the vitreomacular traction has caused a small macular hole, then treatment will be needed. Often this will be with a type of surgery known as a vitrectomy.
This operation involves removing the vitreous gel inside the eye and replacing it with a gas bubble in order to help the macula to heal. Taking the vitreous out stops it from pulling on the retina, and the bubble lightly presses on the hole to encourage it to heal – a bit like a bandage.
The gas bubble will make your vision quite blurry, but over a few weeks, the bubble will get smaller and eventually go away altogether. During this time, the eye will naturally produce some more fluid to replace it.
Can vitreomacular traction resolve itself?
In 10-30% of cases, vitreomacular traction will just resolve itself. It usually takes about 18 months to see a full resolution, but this’ll dependent on the size of the vitreous attachment, as the smaller this is, the higher the chance of it resolving itself naturally.