The aging eye

As we age, we experience vision changes that are part of the natural aging process.

One of the changes that happens is when the jelly-like liquid inside the eye, called the vitreous, detaches from the back of the eye, the part known as the retina.1-3

This separation is natural, and for most people it occurs without any complications.

Retina: the part of the eye that acts as the eye's camera, allowing sight.
Macula: A small, highly specialized area of the retina responsible for clear, detailed vision.
Vitreous: The jelly-like liquid inside the eye.

Vitreomacular adhesion

Sometimes, however, the vitreous (the jelly-like substance in your eye) does not completely separate from the back of the eye. Instead, it stays attached to a specific part of the back of the eye, called the macula, which is responsible for clear vision.1,4-6 This adhesion is a condition called vitreomacular adhesion (VMA).

If the vitreous starts pulling on the macula, vision changes may occur as a result. When this happens, the condition is known as symptomatic vitreomacular adhesion (symptomatic VMA). Although symptomatic VMA doesn’t occur in every case, everyone is at risk. Learn about the symptoms of symptomatic VMA.

Recognize the symptoms

The visual symptoms associated with symptomatic VMA may be serious and may impact your daily activities.

Distorted or wavy vision is the most common sign of symptomatic VMA.7-9

Other common symptoms include7-9:

  • Floaters – small spots that drift or cast shadows in your field of vision
  • Flashes of light
  • Difficulty reading

If you experience any of these symptoms it is essential that you discuss them with your eye care professional. Learn why recognizing and monitoring your symptoms is important.

The images below provide an idea of what you may see in your everyday life
if you have symptomatic VMA.

Normal Vision

Images and lines
appear normal.

Distorted Vision

Lines may appear wavy
instead of straight.

Decreased Visual Acuity

Objects may not appear as
clear, and small details may
be difficult to distinguish.

Central Vision Loss

A hole may appear in
your central vision.

Your vision may worsen over time

Depending on your symptoms, your eye care professional may observe you for several weeks to months to see whether your condition may resolve on its own. This approach is known as "watch and wait."

Early diagnosis is important as symptomatic VMA does not normally cause eye pain. So tell your eye care professional about any symptoms you are experiencing, even those not mentioned here. Your eye doctor may use simple diagnostic tools to determine what is going on.

It is important for your eye care professional to monitor you because in some cases, your condition may worsen, causing a macular hole.

A macular hole happens when persistent pulling removes a part of the macula, which is responsible for clear, detailed vision. A macular hole may worsen your vision and lead to complete vision loss over time.10,11

Waiting to treat symptomatic VMA may increase the risk that additional treatment may be less successful.11-13

Important Safety Information

Click to Expand
Indication

JETREA® (ocriplasmin) Intravitreal Injection, 2.5 mg/mL, is a proteolytic enzyme indicated for the treatment of symptomatic vitreomacular adhesion.

Important Safety Information
Warnings and Precautions
  • A decrease of ≥ 3 lines of best-corrected visual acuity (BCVA) was experienced by 5.6% of patients treated with JETREA and 3.2% of patients treated with vehicle in the controlled trials. The majority of these decreases in vision were due to progression of the condition with traction and many required surgical intervention. Patients should be monitored appropriately.
  • Intravitreal injections are associated with intraocular inflammation/infection, intraocular hemorrhage and increased intraocular pressure (IOP). Patients should be monitored and instructed to report any symptoms without delay. In the controlled trials, intraocular inflammation occurred in 7.1% of patients injected with JETREA vs 3.7% of patients injected with vehicle. Most of the post-injection intraocular inflammation events were mild and transient. If the contralateral eye requires treatment with JETREA, it is not recommended within 7 days of the initial injection in order to monitor the post-injection course in the injected eye.
  • Potential for lens subluxation.
  • In the controlled trials, the incidence of retinal detachment was 0.9% in the JETREA group and 1.6% in the vehicle group, while the incidence of retinal tear (without detachment) was 1.1% in the JETREA group and 2.7% in the vehicle group. Most of these events occurred during or after vitrectomy in both groups.
  • Dyschromatopsia (generally described as yellowish vision) was reported in 2% of all patients injected with JETREA. In approximately half of these dyschromatopsia cases there were also electroretinographic (ERG) changes reported (a- and b-wave amplitude decrease).
Adverse Reactions
  • The most commonly reported reactions (≥ 5%) in patients treated with JETREA were vitreous floaters, conjunctival hemorrhage, eye pain, photopsia, blurred vision, macular hole, reduced visual acuity, visual impairment, and retinal edema.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. You may also report side effects of JETREA online directly to ThromboGenics by clicking here if you are a Patient or here if you are a Health Care Professional.

References:
1. Sebag J, Wang M. Combined spectral-domain optical coherence tomography/scanning laser ophthalmoscopy imaging of vitreous and the vitreoretinal interface. In: Holz FG, Spaide RF, eds. Medical Retina: Focus on Retinal Imaging. Berlin, Germany: Springer-Verlag; 2010:157-168. 2. Ponsioen TL, van Luyn MJ, van der Worp RJ, van Meurs JC, Hooymans JM, Los LI. Collagen distribution in the human vitreoretinal interface. Invest Ophthalmol Vis Sci. 2008;49(9):4089-4095. 3. Larsson L, Österlin S. Posterior vitreous detachment. A combined clinical and physiochemical study. Graefes Arch Clin Exp Ophthalmol. 1985;223(2):92-95. 4. Meiss R. Sensory physiology. In: Rhoades RA, Tanner GA, eds. Medical Physiology. 1st ed. Boston, MA: Little, Brown and Company; 1995:61–89. 5. Fekrat S, Weizer JS. All About Your Eyes. Durham and London. Duke University Press; 2006:9. 6. Johnson MW. Perifoveal vitreous detachment and its macular complications. Trans Am Ophthalmol Soc. 2005;103:537–567. 7. Jaffe NS. Vitreous traction at the posterior pole of the fundus due to alterations in the vitreous posterior. Trans Am Acad Ophthalmol Otolaryngol. 1967;71(4):642-652. 8. Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012;367(7):606-615. 9. Smiddy WE, Michels RG, Glaser BM, deBustros S. Vitrectomy for macular traction caused by incomplete vitreous separation. Arch Ophthalmol. 1988;106(5):624–628. 10. Reese AB, Jones IS, Cooper WC. Macular changes secondary to vitreous traction. Trans Am Ophthalmol Soc. 1966;64:123–134. 11. Sonmez K, Capone A Jr, Trese MT, Williams GA. Vitreomacular traction syndrome: impact of anatomical configuration on anatomical and visual outcomes. Retina. 2008;28(9):1207-1214. 12. Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol. 1995;119(1)55-56. 13. Stalmans P, Lescrauwaet B, Blot K. A retrospective cohort study in patients with diseases of the vitreomacular interface (ReCoVit). Poster presented at: The Association for Research in Vision and Ophthalmology (ARVO) 2014 Annual Meeting; May 4-8, 2014; Orlando, Florida. 14. JETREA [package insert]. Iselin, NJ: ThromboGenics, Inc.; 2014. 15. Ocriplasmin 2nd Periodic Benefit-Risk Evaluation Report. ThromboGenics NV. December 19, 2013.