Vitreomacular Traction

As the eye ages, or in certain pathologic conditions, the vitreous cortex can pull away from the retina, leading to a condition known as posterior vitreous detachment (PVD). This detachment usually occurs as part of the normal aging process.

There are instances where a PVD is incomplete, leaving the vitreous partially attached to the retina, and causing tractional (pulling) forces that can cause anatomical damage. The resulting condition is called vitreomacular traction (VMT) syndrome.
Vitreomacular Traction

Theodore Leng, MD, MS, FASRS. VMT; Retina Image Bank; Year 2017; Image Number 27430


VMT syndrome can lead to different maculopathies or disorders in the macular area (at the center of the retina), such as full- or partial-thickness macular holes, epiretinal membranes, and cystoid macular edema. These disorders are often associated with reduced sharpness of vision (visual acuity) or other visual complications.

The most common symptoms experienced by patients with VMT syndrome are:
Some of these symptoms can be mild and develop slowly; however, chronic tractional effects can lead to continued visual loss if left untreated. In some cases, a distortion of a visual picture could be experienced without necessarily having a reduction in sharpness of vision.


Age-related degeneration of the gel-like vitreous humor leads to the formation of pockets of fluid within the vitreous, causing contraction and loss of volume. The separation of the vitreous gel from the retina occurs as a result of the gel becoming liquid (liquefaction) and the continuous anterior-posterior (front-back) and tractional forces stretching on the macula over time.

Weakening of the attachments of the vitreous cortex and the internal limiting membrane (ILM) of the retina could also lead to partial detachment of the posterior hyaloid membrane, leading to PVD and potentially VMT.

Risk factors

VMT syndrome is most common in older adults and women due to age-related vitreous changes and vitreous liquefaction associated with declining post-menopausal estrogen levels, respectively.

Other risk factors include:

Diagnostic testing

Optical coherence tomography (OCT) is a commonly used and recommended method to noninvasively identify and monitor VMT syndrome. This technology captures cross-sectional images of the retinal layers, including the surface, and allows physicians to evaluate the degree to which vitreomacular tractional forces are distorting the retinal structure.

A dynamic B-scan ultrasound examination could also be performed to provide a detailed evaluation of the vitreoretinal interface.
Figure 1

Image courtesy of Alex P. Hunyor, MD.
SD-OCT appearance of right eye showing vitreomacular traction
Figure 2

Image courtesy of Alex P. Hunyor, MD.
SD-OCT appearance of right eye following vitrectomy surgery

Treatment and Prognosis

There are currently 4 main options for treating VMT syndrome:
Most patients with VMT maintain good visual acuity in the affected eye, even if treatment is required.

Retinal neovascularization is a potentially serious complication of BRVO in which an inadequate blood supply (ischemia) causes abnormal new blood vessels  to grow on the surface of the retina. This growth can further decrease vision by causing  vitreous hemorrhage that causes floaters and loss of vision, retinal detachment, and glaucoma.

When neovascularization develops, scatter laser photocoagulation therapy is used to create burns in the area of the vein  occlusion (blockage). The aim is  to try to lower the oxygen demand of the retina and thus stop the abnormal blood vessels from growing. Patients receive an  anesthetic to numb the eye  and make the treatment more comfortable.

Scatter photocoagulation has been shown to reduce neovascularization-related complications from 60% to 30%. Because only a few patients develop abnormal new blood vessels in the retina, not many need scatter photocoagulation treatment.

Eye Procedures

Intraocular Injections
There are currently 3 anti-VEGF drugs:

Lasik Eye Surgery

Contact Info

San Diego
7695 Cardinal Court, Suite 100 San Diego, CA 92123
Office: (858) 609-7100
Fax: (858) 609-7106

3231 Waring Court, Suite S, Oceanside, CA 92056
Office: (760) 631-6144
Fax: (760) 724-3920


San Diego


Get In Touch

Please enable JavaScript in your browser to complete this form.