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Online Exclusive: Using OCT for vitreoretinal traction syndrome

A pictorial presentation of how this technology improves the specificity with which practitioners can identify this syndrome

By: NICK FOGT, OD, PHD, J.P. MASZCZAK, OD, TATEVIK MOVSISYAN, OD
Optometric Management July 9, 2024

Optometrists are instrumental in identifying vitreoretinal traction disorders. Specifically, their ability to do so can play a role in preventing related visual function decline. Optical coherence tomography (OCT) has improved the specificity with which ODs can identify this syndrome. This is because it allows for enhanced imaging of the vitreomacular interface.

Here we present OCT images of vitreoretinal traction syndrome, to demonstrate this technology’s clinical utility.

 

Figure 1: Vitreomacular adhesion or VMA (Stage 0) presents as a vitreous that is partially detached from the retina but remains attached at the macula.1 VMA may be either focal (<=1500 µm) or broad (>1500 µm). Asymptomatic VMA cases can be monitored once a year.

 

Figure 2: Vitreomacular traction or VMT (Stage 1) presents with the vitreous remaining attached to the macular area, and the possible presence of cystic spaces within the retinal tissue where the inner and outer retina are separated. (Note the cystic spaces and foveal detachment in this patient.) As in VMA, VMT can be considered focal (<=1500 µm) or broad (>1500 µm).1 VMT can be monitored every 2-6 months, but referral to a retinal specialist is necessary if any of the following are present: significant metamorphopsia (detected at the examination or during patient self-monitoring with an Amsler grid), a scotoma, or visual acuity worse then 20/40.
Figure 3: A full-thickness macular hole (FTMH) can result from vitreomacular traction (VMT), as shown here. In a FTMH, there is a (lateral) break in both the inner and outer retinal tissue. Note the round and red holes, which can have a cuff of edema surrounding them. These holes are classified as follows: Stage 2 holes are small (<250 µm) or medium (250-400 µm) in diameter with VMT, Stage 3 holes are medium or large (>400 µm) in diameter with VMT, and Stage 4 holes are small, medium, or large in diameter with no VMT.1 Referral to a retinal specialist is necessary in all cases of FTMH.
Figure 4: A macular pseudohole is a type of non-full-thickness macular hole (NFMH) that results from contraction of an epiretinal membrane around the fovea.8 The OCT of a macular pseudohole may be characterized by steep (vertical) foveal walls and normal macular thickness. While macular pseudoholes are often stable and may not demonstrate anatomical progression,9 patients should be monitored every 2-3 months or referred to a retinal specialist if visual acuity is less than roughly 20/40.
Figure 5: A lamellar hole is a NFMH that may have the following features on OCT: distortion of the walls of the foveal depression/foveal contour, a (lateral) break in the inner fovea, an anterior-posterior split (i.e. schisis) between retinal layers, and an intact photoreceptor layer.1 While most lamellar holes are stable, in one review paper about 13-21% of eyes with a lamellar hole showed anatomical degradation after 18-24 months, and about 20% had reduced visual acuity of more than 5 letters at 3 years.10 In one study, about 10% of eyes with (non-treated) lamellar holes developed full thickness holes.11 Lamellar holes should always be referred to a retinal specialist. 

A call to action
Because vitreoretinal traction syndrome can result in visual function decline and can be associated with other ocular and retinal conditions such as high myopia, age-related macular degeneration, diabetic macular edema, and retinal vein occlusion, it makes sense for the optometrist to keep this syndrome on their radar.12,13 The use of OCT allows for this.

References

  1. Duker, J. S., Kaiser, P. K., Binder, S., de Smet, M. D., Gaudric, A., Reichel, E., Sadda, S. R., Sebag, J., Spaide, R. F., & Stalmans, P. (2013). The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology, 120(12), 2611–2619.
  2. John, V. J., Flynn, H. W., Jr, Smiddy, W. E., Carver, A., Leonard, R., Tabandeh, H., & Boyer, D. S. (2014). Clinical course of vitreomacular adhesion managed by initial observation. Retina, 34(3), 442–446.
  3. García-Layana, A., García-Arumí, J., Ruiz-Moreno, J. M., Arias-Barquet, L., Cabrera-López, F., & Figueroa, M. S. (2015). A review of current management of vitreomacular traction and macular hole. Journal of ophthalmology, 2015, 809640
  4. American Academy of Ophthalmology. Idiopathic Macular Hole Preferred Practice Pattern®. 2019. Elsevier Inc.
  5. Garg, A., Ballios, B. G., & Yan, P. (2021). Spontaneous closure of an idiopathic full-thickness macular hole: A literature review. Journal of vitreoretinal diseases, 6(5), 381–390.
  6. Morawski, K., Jędrychowska-Jamborska, J., Kubicka-Trząska, A., & Romanowska-Dixon, B. (2016). The analysis of spontaneous closure mechanisms and regeneration of retinal layers of a full-thickness macular hole: Relationship with visual acuity improvement. Retina, 36(11), 2132–2139
  7. Mansour, A.M., Parodi, M., Uwaydat, S.H,, Charbaji, S., Ascaso, J., Mansour, H.A., Tripathy, K., & Marcelo Barbante Casella, A. (2023). Idiopathic macular hole: Algorithm for nonsurgical closure based on literature review. Journal of ophthalmic & vision research, 18(4), 424–432.
  8. Michalewska, Z., Michalewski, J., Odrobina, D., & Nawrocki, J. (2012). Non-full-thickness macular holes reassessed with spectral domain optical coherence tomography. Retina, 32(5), 922–929.
  9. Steel, D. H., & Lotery, A. J. (2013). Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye, 27 Suppl 1, S1–S21.
  10. Danielescu, C., Stanca, H. T., & Balta, F. (2020). The management of lamellar macular holes: A Review. Journal of ophthalmology, 2020, 3526316.
  11. Chehaibou, I., Tadayoni, R., Hubschman, J. P., Bottoni, F., Caputo, G., Chang, S., Dell'Omo, R., Figueroa, M. S., Gaudric, A., Haritoglou, C., Kadonosono, K., Leisser, C., Maier, M., Priglinger, S., Rizzo, S., Schumann, R. G., Sebag, J., Stamenkovic, M., Veckeneer, M., & Steel, D. H. (2024). Natural history and surgical outcomes of lamellar macular holes.  Retina, 8(3), 210–222.
  12. Lin, C. W., Ho, T. C., & Yang, C. M. (2015). The development and evolution of full thickness macular hole in highly myopic eyes. Eye, 29(3), 388–396.
  13. Wong D. (2011). Is traction the cause or the effect?. Graefe's archive for clinical and experimental ophthalmology, 249(6), 809–810.
NICK FOGT, OD, PHD

NICK FOGT, OD, PHD, is a professor of Optometry and Vision Science at the Ohio State University College of Optometry.

J.P. MASZCZAK, OD

J.P. MASZCZAK, OD, is an associate professor of Optometry at the Ohio State University College of Optometry

TATEVIK MOVSISYAN, OD

TATEVIK MOVSISYAN, OD, is a staff optometrist and clinical preceptor at the Detroit Veterans Administration Eye Clinic.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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