What is vitreomacular traction (VMT)?
In this condition, the back surface of the vitreous (the gel which fills the main cavity of the eye) pulls on, and sometimes distorts, the architecture of the macula which is the part of the retina responsible for your main, central vision. The very central part of the macula is the fovea, and the condition is sometimes referred to as vitreofoveal traction (VFT).

What are the symptoms of VMT?
Early VMT can have no symptoms at all, and normal vision. More advanced VMT can cause reduced central vision, often described as blurring or distortion of straight lines.

What happens if VMT is not treated?
The natural history of VMT can lead to several different outcomes:

  • it can spontaneously resolve, either leaving a lamellar macular hole (which normally doesn’t require any treatment) or a normal macular profile
  • it can remain stable over many years
  • it can cause progressive macular distortion and reduced vision
  • it can cause a full-thickness defect in the macula (a macular hole)
This 79 year old man was referred to Mr Shah in December 2014 with epiretinal membrane (ERM). Serial OCT scanning demonstrated progressive vitreomacular traction and ERM as well as some features consistent with myopic traction maculopathy. A, Macular OCT scan in Dec 2014 shows ERM and some retinal distortion B, OCT in March 2015 shows marked traction and progressive retinal distortion C, After vitrectomy surgery to relieve traction and remove the ERM, performed by Mr Shah in May 2015, this post-operative OCT from July 2015 shows marked improvement in macular architecture. This patient experienced a marked improvement in vision following surgery.
This 79 year old man was referred to Mr Shah in December 2014 with epiretinal membrane (ERM). Serial OCT scanning demonstrated progressive vitreomacular traction and ERM with some features of myopic traction maculopathy.
A, Macular OCT scan in Dec 2014 shows ERM and some retinal distortion
B, OCT in March 2015 shows marked traction and progressive retinal distortion
C, After vitrectomy surgery to relieve traction and remove the ERM, performed by Mr Shah in May 2015, this post-operative OCT from July 2015 shows marked improvement in macular architecture.
This patient experienced a marked improvement in vision following surgery.

What treatments are available for VMT?
Cases of early VMT can safely be observed, hoping for spontaneous resolution. For more advanced or progressive VMT, the gold standard treatment is an operation to remove the vitreous gel from the eye and thereby relieve the traction (pulling) directly – this operation is called a vitrectomy.

In recent years an alternative treatment has become available called ocriplasmin. This is an injection into the eye which is designed to chemically digest the links between the gel and the retina. Unfortunately many surgeons have described untoward side effects with this medicine after its release, and Mr Shah does not currently offer it to any patients, on account of concerns about its safety (see relevant blog posts (tag: ocriplasmin) for further information).