What is vitreomacular traction and macular hole?

The back of the eye is filled with a gel-like fluid called the vitreous which helps the eye to keep its shape. As people age the vitreous becomes more watery and starts to shrink. It normally pulls harmlessly away from the retina (this is known as posterior vitreous detachment) but sometimes the retina can tear in the process. If this happens at the macula, the centre of the retina, where the vision is sharpest and colour vision is best, a hole can develop. This causes a sudden drop in vision in the affected eye. There are also other, rarer causes of macular hole. Macular hole is not related to age-related macular degeneration.

A special examination known as optical coherence tomography (OCT) has been available since 1990. This works like an ultrasound, but using light rather than sound. It is painless and quick. There is no contact with the eye and no radiation. OCT shows the structures inside the eye, including the retina and macula, in great detail.

How is vitreomacular traction and macular hole managed?

If an optometrist finds a macular hole, he or she will refer the patient to an ophthalmologist (eye doctor) who will probably recommend an operation, as there are no eye drops, medicines or diets that can help. The most usual operation for macular hole is called a vitrectomy, in which the vitreous pulling on the retina is removed. A bubble of gas is then placed inside the eye to help the retina to settle back into place and the macular hole to seal. In most cases this results in better vision.

An eye that has had a vitrectomy is likely to develop cataract, but this can be dealt with later by a routine operation. Surgeons sometimes perform the two operations at the same time. Some patients will be offered another kind of treatment which involves injecting a substance into the eye. This is Ocriplasmin, an enzyme that liquefies the vitreous, releasing tension on the retina.