Vitreomacular adhesion (VMA) is an eye condition in which the gel-like substance is abnormally attached to the central retina. 

Clear gel-like substance between lens and retina in eye referred as vitreous. While it is composed of water, collagen, and hyaluronic acid. 

Macula in retina is important for sharp central vision needed for reading and facial recognition. 

Age-related vitreous changes cause syneresis leads to posterior vitreous detachment when the gel shrinks and separates from the retina. 

Stages of VMA are: 

Focal VMA 

Broad VMA 

Vitreomacular Traction 

It occurs due to: 

Blurred or distorted vision 

Difficulty in reading or recognizing faces 

Visual disturbances 

VMA is an age-related condition, prevalence rises with age. VMA prevalence in general population ranges from 2% to 16%. 

VMA prevalence in general population ranges from 2% to 16%. High myopia increases risk of VMA due to elongated shape causing vitreous degeneration and macula adhesion. 

Diabetic retinopathy can increase risk of VMA development due to structural changes in diabetic eyes. 

Community-based studies with OCT provide prevalence data on VMA in diverse populations. 

Dynamic eye movements and vitreous gel cause anteroposterior forces with side-to-side traction, which lead to macular distortion. 

Persistent vitreomacular adhesion causes front-to-back traction to deform the macula and disrupts retinal structure. 

Vitreous is firmly attached to retina at various areas including vitreous base, optic disc, blood vessels, and macula. 

Vitreous collagen changes are vital for VMA. Disrupted collagen matrix can cause uneven detachment and adhesion. 

Causes for VMA are: 

Age-Related Factors: 

Aging Process 

Vitreous Liquefaction 

Biomechanical Factors: 

Tractional Forces 

Vitreous Degeneration 

Molecular and Cellular Factors: 

Adhesive Molecules 

Cellular Changes 

Ocular Conditions and Comorbidities: 

Myopia 

Diabetic Retinopathy 

Ocular Surgery 

Focal VMA has better prognosis and likely resolves without intervention. 

Prognosis is influenced by vitreous traction on the macula. Minimal traction can be asymptomatic, while significant traction causes visual distortion.
Elderly patients face more VMA risk due to vitreous degeneration and age-related ocular issues. 

Patients with mild/no symptoms have better prognosis. Severe symptoms like metamorphopsia or visual acuity loss suggest worse prognosis. 

Vitreomacular adhesion is an age-related condition, and it affects in age group of >50 years old. 

Visual Acuity Testing 

Fundus Examination 

• Symptomatic symptoms as: 
• Gradual Onset  
• Decreased Visual Acuity 
• Metamorphopsia 
• Blurred Vision 
• Central Scotoma 
• Acute symptoms as: 
• Sudden Visual Changes 
• Flashes and Floaters 

Ocriplasmin enzyme breaks down proteins in vitreous gel for adhesion release. It administered through intravitreal route as injection. 

It is indicated in symptomatic VMA in cases with no significant epiretinal membrane or broad adhesions. 

In diabetic macular edema or neovascular AMD cases, use of anti-VEGF injections to reduce macular edema and enhance visual results. 

Use of intravitreal corticosteroids should be considered in some cases to reduce inflammation and macular edema. 

Regular monitoring for asymptomatic patients or those with mild symptoms and no macular traction using follow-up visits and OCT imaging. 

Ophthalmology

Improve lights/brightness in living room and working areas to prevent eye strain and enhance visual clarity. 

Use magnifying glasses and reading lenses to assist with reading and performing detailed tasks. 

Ensure all walking pathways/routes within the home are clear of obstacles. 

Proper education and awareness about vitreomacular adhesion should be provided and its related causes with management strategies. 

Appointments with an ophthalmologist and preventing recurrence of disorder is an ongoing life-long effort. 

Ophthalmology

Ocriplasmin: 

It targets the proteins in the vitreous gel and the vitreoretinal interface. It initiates the breakdown of the vitreous adhesion to the macula and promotes vitreomacular separation. 

Ophthalmology

Vitrectomy is a surgical procedure to remove vitreous gel and fix reposition of retina for better vision. 

Ophthalmology

In the initial diagnosis phase, evaluation of medical history, ophthalmic examination, and optical coherence tomography (OCT) to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of proteolytic enzymes and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the ophthalmologist are scheduled to check the improvement of patients along with treatment response.