Mr Nicholas Glover  - Consultant Cataract & Vitreoretinal Surgeon
Vitreomacular Adhesion

The natural aging process of the vitreous results in its liquefaction and separation from the retina in many eyes. In some eyes, the adhesion between the vitreous and the macula does not weaken sufficiently to allow for separation of vitreous, resulting in a condition known as  Symptomatic vitreomacular adhesion (VMA)

VMA is an increasingly recognized sight-threatening disease of the retina. It may lead to symptoms such as distortion, decreased visual acuity, and central visual defects. Even patients with good visual acuity may have moderately severe symptoms. 

VMA can cause progressive traction on the retina resulting in anatomical damage, vitreomacular traction (VMT) which may lead to severe visual consequences, including macular hole



Vision in patients with untreated VMT deteriorates over time, while spontaneous separation of vitreomacular traction occurs infrequently. 

Diagnosis

Due to the advent of optical coherence tomography (OCT), the recognition of   Vitreomacular adhesion (VMA) and vitreomacular traction (VMT)  increased in recent years. OCT imaging allows specialists to confirm findings of the physical evaluation and to make diagnoses prior to detectable symptoms.

Management

Current options for patients with symptomatic VMA and VMT are “watchful waiting”, medical treatment (Ocriplasmin injections) or a surgical procedure (vitrectomy). 

The treatments available separate vitreous adhesions from the retinal surface. The goal of therapy for these conditions is to relieve tractional effects on the macula, thereby resolving the underlying condition with subsequent functional improvement 

Studies suggest that earlier treatment of VMT may help achieve optimal visual outcome.