Vitreomacular traction syndrome (VMT)

What is vitreomacular traction?

Vitreomacular traction syndrome (VMT) is a condition that occurs when the eye’s vitreous does not detach completely from the retina at the back of the eye. Rather, part of the vitreous stays attached to and tugs on the macula in the center of the retina. This can lead to vision distortion and vision loss.

VMT is rare but is more common with certain underlying conditions, such as age-related macular degeneration or diabetic retinopathy. Some cases of vitreomacular traction may resolve on their own without affecting eyesight.

If you notice sudden vision changes, like seeing flashes of light in your side (peripheral) vision, you should see an eye doctor. They can examine your eyes and determine the best way to treat your case.

Understanding vitreous traction

To better understand vitreomacular traction, you must first understand posterior vitreous detachment. This is a common, age-related event that happens within the eyes.

Vitreous humor is the fluid that fills a portion of the eye called the vitreous cavity. It works by maintaining the eye’s shape and providing it with nutrients. It’s made up mostly of water but also includes collagen, salts, sugars and proteins, which give it a jelly-like consistency.

The vitreous cavity lies between the eye’s lens and the retina — the light-sensitive tissue that lines the back of the eye. A bunch of tiny fibers in the vitreous help connect it to the retina.

Around age 50, the collagen in the vitreous starts to break down and causes the vitreous to liquefy. Going from a jelly-like consistency to a water-like consistency causes the vitreous to shrink and pull on the fibers that connect it to the retina.

Normally, the fibers break away from the retina cleanly, like removing a sticker from a piece of paper. This is known as vitreous detachment and is a common occurrence in aging eyes.

In vitreomacular traction syndrome, the vitreous fibers get caught on the macula, which is the most sensitive part of the retina. The macula is located in the middle of the retina (like a bull’s eye) and is responsible for important aspects of eyesight, such as color vision and central vision.

When vitreous fibers get caught on the macula, they can tug and pull on it, which can damage the macula. Macular damage that goes untreated can result in vision loss.

SEE RELATED:  How vision changes as you age

How VMT affects the eyes

Symptoms of VMT often develop gradually and vary in severity. Prolonged symptoms may further damage vision if left untreated. The most common ways VMT affects the eyes are:

• Blurred vision

• Distorted or warped vision (metamorphopsia)

• Blind spots (scotoma)

• Perceiving objects as smaller than they actually are (micropsia)

• Reduced vision, which may affect daily tasks like reading

The sudden onset of these symptoms may indicate severe VMT, which is a serious condition. Many of these symptoms may also indicate other vision conditions, which is why an eye exam is a must if you’re experiencing any of them.

Risk factors for vitreomacular traction

While VMT can occur with anyone experiencing vitreous detachment, there are a few things that make a person more likely to experience it. Most risk factors are underlying eye conditions, such as:

• Diabetic retinopathy – Blood vessels in the retina are affected by unmanaged blood sugar levels.

• Wet age-related macular degeneration – Abnormal blood vessels leak blood and fluid in the back of the eye.

• Diabetic macular edema – Leaky blood vessels cause fluid to collect in the macula.

• High myopia – A prescription of -6.00 D or greater is considered severe nearsightedness, or high myopia.

• Retinal vein occlusion – The vein that’s responsible for draining blood from the retina becomes blocked.

Another risk factor is being a postmenopausal woman, as studies associate postmenopausal estrogen levels with the thinning of vitreous fluid.

Complications of VMT

If left untreated, vitreomacular traction can lead to other problems in the retina. These include:

• Epiretinal membranes – Thin, semi-translucent tissue that forms over the macula, also called a macular pucker

• Cystoid macular edema – Small cysts that develop in the middle of the macula and fill with fluid

• Macular hole – A hole in the center of the macula that occurs when vitreous fibers pull too hard and cause a tear in the retina

These complications present similarly to VMT, so it’s important to see an eye care professional as soon as you notice symptoms. Delaying treatment can result in irreversible vision loss.

SEE RELATED: Diabetic eye issues

Advanced treatments for VMT

There are multiple treatment strategies for managing vitreomacular traction syndrome. Your eye doctor will examine the status of your condition and suggest the best strategy for your case.

The “wait and see” method

Some cases of vitreomacular traction are mild and do not affect vision. In cases like this, your optometrist will likely recommend monitoring your symptoms and watching for changes. An Amsler grid can easily be used at home to determine whether eyesight is affected or not.

Daily testing with the Amsler grid and regular follow-up appointments with your eye care provider can effectively manage mild symptoms of vitreomacular traction.

Medication 

Patients who have moderate to severe vitreous traction, and don’t want the risks associated with surgery may benefit from Jetrea (ocriplasmin). This is a single-dose injection that’s administered into the eye. It works by dissolving a specific protein in the eye and treats VMT.

Potential side effects of Jetrea include:

• Breathing difficulty

• Eye floaters

• Eye redness and pain

• Swelling

• Conjunctival hemorrhage

• Photophobia (light sensitivity)

• Hives

• Blurry vision

• Flashes of light

• Changes in vision

• Yellowing of vision

Discuss potential side effects with your eye doctor when deciding the best treatment route for your vitreomacular traction syndrome.

Surgery 

Pars plana vitrectomy (PPV) is a surgical procedure used to treat vitreomacular traction syndrome. This type of vitrectomy allows the eye surgeon access to the back of the eye via the pars plana — a specific area of the sclera (white part of the eye).

Once the eye surgeon gains access to the back of the eye, they remove the vitreous humor and manually release the fibers tugging on the retina. If necessary, they will also peel off any membranes that may have developed over the macula.

After this is done, the surgeon will inject the eye with a saline solution to replace the vitreous humor that was removed.

Pneumatic vitreolysis

This non-invasive procedure involves injecting a gas bubble into the eye to help release the vitreous that’s tugging on the macula. To perform a pneumatic vitreolysis, the ophthalmologist numbs the eye with anesthesia.

Once the eye is numb, the surgeon injects 3 cc of a specific gas, which creates a small bubble in the eye’s vitreous fluid. The goal of the procedure is for the bubble to encourage complete vitreous detachment, thus relieving the symptoms of VMT. This method can also be used for patients who have a small macular hole.

After surgery, your eye doctor may recommend that you lie face-down for a certain period of time. It’s important to follow their post-operative instructions to achieve the best results.

ICD 10 code for vitreomacular traction

International Classification of Diseases (ICD) has a system that uses codes to reflect all medical procedures, diagnoses and symptoms. The most current system is the 10th revision, which is where you get the ICD-10.

ICD codes are used by doctors and insurance providers when processing health insurance claims. From a patient standpoint, knowing the ICD code for your specific diagnosis or procedure can help you when determining insurance coverage and out-of-pocket cost.

The ICD-10 code for vitreomacular traction syndrome is H43.82. For more information, or to see other ICD-10 codes associated with VMT, the Centers for Disease Control and Prevention has a code browser tool to help.

Page published on Tuesday, July 25, 2023

Page updated on Tuesday, August 1, 2023

Medically reviewed on Thursday, July 13, 2023