Vitreomacular Traction

An incomplete separation of the vitreous gel that leaves it anchored to the macula, pulling on the delicate central retina and distorting the vision needed for reading and fine detail work.

At a Glance

Vitreomacular traction (VMT) is an abnormal, incomplete posterior vitreous detachment in which the vitreous gel remains persistently attached to the fovea — the center of the macula. Instead of peeling away cleanly, it exerts upward pulling forces that distort the macula's delicate architecture and blur central vision. If untreated, VMT can progress to a full-thickness macular hole.

Key Facts

Diagnosed by OCT Can progress to macular hole Affects central vision only

What Is Happening

•Vitreous partially separates from the retina (incomplete PVD)
•Remaining adhesions at the fovea pull the macula upward
•OCT shows vitreous anchored as a thick band over the fovea
•Cystic changes and retinal layer disruption develop over time

Common Symptoms

•Metamorphopsia — straight lines appear wavy or bent
•Blurred central vision
•Micropsia (objects appear smaller than normal)
•Floaters; gradually worsening visual acuity

Risk Factors

•Age-related vitreous changes (same as PVD risk factors)
•Age 50+, high myopia
•Often co-exists with epiretinal membrane
•Prior eye surgery or vitreoretinal inflammation

How It's Diagnosed

OCT is the definitive test — it shows the vitreous as a reflective band attached to the fovea, elevated foveal contour, and any cystic or lamellar changes. Dilated fundus exam may hint at the diagnosis.

Treatment Options

Observation if symptoms are mild and stable. Ocriplasmin (Jetrea) — a single injectable enzyme that dissolves the vitreoretinal adhesion in selected cases. Vitrectomy surgery is the most reliable option for releasing traction and preventing macular hole.

⚠ Contact Your Doctor Promptly If You Notice

•Worsening central distortion or wavy lines
•A new dark or blank spot appearing in central vision
•Rapid decline in reading vision
•Any sudden change in the character of your symptoms

What is Vitreomacular Traction?

OCT Image Area

Vitreomacular traction is a condition that falls along the spectrum of vitreoretinal interface disease. In a healthy, aging eye, the vitreous gel gradually peels away from the retina in a process called posterior vitreous detachment (PVD). When this separation proceeds normally, the result is simple PVD with floaters and occasional flashes.

VMT occurs when the vitreous fails to disengage cleanly at the macula. Instead, it remains physically tethered to the fovea — the center of the macula — through persistent adhesions. As the vitreous continues its slow forward collapse, these attachments exert upward and inward pulling forces on the delicate central retina. The macula is remarkably sensitive to mechanical distortion; even subtle displacement of its photoreceptor layer translates into visible distortion of central vision.

VMT is best visualized using optical coherence tomography (OCT), which shows the vitreous attachment as a thick, reflective band bridging the vitreoretinal interface above the fovea. OCT also reveals the downstream consequences: elevation and irregularity of the foveal contour, cystic changes within the retina, and sometimes a small opening in the foveal tissue that may herald a full macular hole.

Relationship to Macular Hole

Persistent VMT is a known precursor to full-thickness macular hole. Ongoing traction progressively separates retinal layers, first creating a lamellar (partial-thickness) defect and eventually a full-thickness hole. Early identification and treatment of VMT can prevent this progression.

Symptoms

VMT predominantly affects central vision because the traction site is directly at the fovea. Symptoms may be subtle at first and worsen gradually as the traction increases.

Metamorphopsia

Straight lines — such as door frames, text lines, or window blinds — appear wavy, bent, or distorted.

Blurred Central Vision

Difficulty with detail tasks such as reading, recognizing faces, or seeing fine print clearly.

Micropsia

Objects in the central field appear smaller than they actually are, or smaller than the same object viewed with the other eye.

Reduced Visual Acuity

A measurable decrease in best-corrected vision that may worsen over months if traction progresses.

Floaters

New floaters are common as the vitreous partially separates from other parts of the retina even while remaining attached at the macula.

Progressive Worsening

Unlike benign PVD symptoms that improve over time, VMT symptoms often worsen gradually if the traction is not relieved.

Diagnosis

OCT is the essential tool for diagnosing VMT. It allows the retina specialist to directly visualize the vitreoretinal interface, quantify traction, and monitor progression or response to treatment.

OCT — The Gold Standard

High-resolution OCT scans display the vitreous attachment as a hyper-reflective band above the fovea and reveal the downstream structural consequences — elevation of foveal tissue, cystic spaces within retinal layers, and any early macular hole formation. Serial OCT scans track whether traction is stable or increasing.

Dilated Eye Exam

A comprehensive dilated examination evaluates the full retina, rules out other causes of central vision distortion, and assesses the degree of vitreous involvement. The Amsler grid is a useful home-monitoring tool to detect changes between visits.

Treatment Options

The appropriate treatment depends on symptom severity, visual acuity, OCT findings, and whether the traction is progressing. Not all cases require immediate intervention.

Observation

For patients with mild traction, good visual acuity, and no significant structural change on OCT, active monitoring with serial scans every three to six months is appropriate. A small proportion of VMT cases resolve spontaneously when the vitreous finally completes its separation. Amsler grid home monitoring helps detect any deterioration between appointments.

Ocriplasmin (Jetrea)

Pharmacologic vitreolysis

Ocriplasmin is a recombinant protease enzyme injected into the vitreous as a single treatment. It cleaves proteins at the vitreoretinal interface — primarily fibronectin and laminin — dissolving the molecular bonds that keep the vitreous attached to the macula. In appropriate candidates, the vitreous releases from the fovea within a month of injection, relieving traction without surgery.

Best candidates: Patients with focal VMT (small attachment zone ≤ 1500 µm), no epiretinal membrane, and relatively preserved visual acuity. Success rates are lower in the presence of an epiretinal membrane or very broad vitreous attachment.

Vitrectomy

Surgical release of traction

Pars plana vitrectomy remains the most reliably effective treatment for VMT. During the procedure, the surgeon removes the vitreous gel and mechanically peels away any adhesions at the foveal surface, immediately and completely relieving traction. An internal limiting membrane (ILM) peel may be performed simultaneously to reduce the risk of epiretinal membrane formation.

Vitrectomy is preferred when VMT is broad, associated with an epiretinal membrane, has not responded to Jetrea, or when vision has deteriorated significantly. Visual recovery after surgery varies; most patients experience improvement over weeks to months.

Related Conditions

Macular Hole

A potential complication of untreated VMT — persistent traction can progress to a full-thickness hole in the center of the macula.

Epiretinal Membrane

VMT and epiretinal membrane frequently coexist; scar tissue on the retinal surface can add additional tractional forces.

Posterior Vitreous Detachment

VMT is an incomplete PVD — understanding the normal separation process helps clarify why incomplete detachment causes problems.

References & Learn More

ASRS

American Society of Retina Specialists patient information on vitreomacular traction.

AAO EyeWiki

American Academy of Ophthalmology EyeWiki article on vitreomacular traction syndrome.

NEI

National Eye Institute resources on retinal and vitreous conditions.

TrialFlow Patient Education

Patient Information

Date: _______________

Patient: _______________

Vitreomacular Traction (VMT)

What Is It?

VMT occurs when the vitreous gel in the eye fails to separate cleanly from the macula and remains attached, pulling on the central retina. This traction distorts the macula's structure and causes blurred or wavy central vision. OCT imaging is used to diagnose and monitor VMT. If untreated, it can progress to a macular hole.

Symptoms to Watch For

Distorted central vision — straight lines appear wavy or bent (metamorphopsia)
Blurred or reduced sharpness in central vision
Objects appearing smaller than normal (micropsia)
Difficulty reading or recognizing faces
New floaters

Treatment

Observation with serial OCT scans every 3–6 months for mild cases
Ocriplasmin (Jetrea) injection — dissolves vitreoretinal adhesion without surgery
Vitrectomy — surgical removal of vitreous and release of traction
Amsler grid home monitoring to detect changes between appointments

⚠ Seek Immediate Help If:

Sudden worsening of central vision or increased distortion
A new blank area in the center of your sight (possible macular hole)
Any rapid change in vision between scheduled appointments

Go to the emergency room or call your retina specialist immediately.

Follow-Up Instructions

Return for scheduled OCT monitoring as directed. Use the Amsler grid daily and report any worsening distortion promptly. Discuss treatment options with your retina specialist if vision declines or traction progresses on imaging.

Doctor's Notes