Which treatment you'll have for vitreomacular adhesion (VMA) depends on your symptoms. If you have none, you may not need to be treated right now. But if you’ve noticed changes to your vision, you should see your eye doctor.
First, she’ll dilate your pupil and look inside your eye. You’ll also get a test called optical coherence tomography (OCT). That shows the back of your eye. She needs to do that to be sure you have VMA and to see if you have any damage inside your eye that needs treatment.
OCT can show the jelly inside your eye, called the vitreous. It sticks to your retina if you have VMA. Your test can also show damage to something called your macula. That’s the part of your retina that gives you clear, detailed eyesight.
Your eye doctor can check up on you with regular exams and OCT scans. If the vitreous gel is pulling on your macula but it has not affected your vision, your doctor may suggest that you just watch it and wait for any symptoms. Sometimes this gets better by itself.
You’ll follow up every 6 months to see if VMA causes any complications.
One complication, called a macular hole, is a small break. If you have that but don’t have symptoms, you may start treatment. Because there are options to treat VMA, you may not want to wait to see if your eye gets worse.
One treatment for VMA is a medication called ocriplasmin (Jetrea) that is injected into your eye. It can ease the tugging of your vitreous gel on your macula. It’s an alternative to eye surgery.
This shot is only used in people who have symptoms like vision loss. You get one shot into your eye.
Side effects like these are possible:
- “Floaters” in your vision
- Bleeding in your conjunctiva, the tissue that covers the white of your eye
- Eye pain
- Light flashes
- Blurred or unclear vision
- Vision loss
- Edema, or swelling, in your macula or retina
Injection treatment is not right for everyone with VMA. It may only work in half or fewer of people with it.
If you have only a small area of adhesion, a small to medium macular hole, or you want to delay or avoid eye surgery, this may be an option.
If you’re younger than 65, the shot may work better.
A few different surgeries can help:
Vitrectomy: This removes the vitreous gel and stops it from pulling on the macula. This treatment has been around for about 40 years. New techniques make it safer and more effective.
This could be right for you if your VMA has caused severe changes or some loss to your vision.
Your eye surgeon will use a small suction and cutting device to take out part of the gel inside your eye. Sometimes, a gas bubble is put into the space where the gel used to be. This can ease the pull.
Vitrectomy helps ease symptoms and give you back lost vision. It works in about 90% of people.
Small-gauge vitrectomy: Your eye surgeon may choose to use a more recently developed instrument of smaller size to remove the vitreous gel to relieve the pulling on the macula.
You get local anesthesia. Because a smaller cutting/suction hand piece is used and the cut is smaller, you don’t need any sutures or stitches. Recovery time is quicker. You may also have less discomfort afterward.
ILM peeling: You may need internal limiting membrane (ILM) peeling surgery if your VMA has led to other complications like a hole in your macula. Your doctor can strip away part of the membrane to treat the problem.
Your surgeon may use a dye to stain the membrane so it’s easier to see where to peel. This is called chromodissection.
If you have a gas bubble put in your eye during surgery, your doctor may have you lie facedown for up to a week afterward. This can help keep a macular hole closed because the gas presses against it.
Some doctors suggest you do this for a shorter time, or not at all.
There are possible risks to surgery for VMA, such as:
- Macular pucker
- Macular holes
- Fluid in your eye
- Macular atrophy
- Damage to your retina pigment
- Vision field problems
- Low eye pressure, called hypotony, that can harm your vision
After your surgery, you’ll have regular OCT tests for about a year to check how your eye heals and vision gets better.