Understanding the potential visual
impairment in patients

Symptomatic VMA is becoming increasingly recognized as a sight-threatening disease related to aging.4 It is a progressive disease that can lead to serious outcomes such as macular hole and vision loss.5-7 It may also impair your patients’ ability to perform routine tasks.3,8,9

VMA occurs when the vitreous cannot completely separate from the macula as part of the normal aging process. VMA can lead to symptomatic VMA if the adhesion is strong enough to cause pulling on the macula.

This pulling is known as vitreomacular traction (VMT).4 It can harm the macular structure and lead to loss in visual acuity (VA).

Recognizing the signs and symptoms

The most common and recognizable symptom of symptomatic VMA is metamorphopsia, or distorted vision. Patients may see wavy lines.3,8,9

Metamorphopsia is an anomaly of visual perception in which objects appear distorted in shape, size, or location. It results from disease of the retina or imperfection of the media.10

Other symptoms of
symptomatic VMA include3,8,9:

  • Floaters
  • Flashes of light
  • VA changes
  • Central microscotoma

The images below provide an idea of what patients may be seeing in their
everyday lives if they 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.

Given that symptomatic VMA is a sight-threatening disease, if your patients report any symptoms that could suggest symptomatic VMA, there are simple diagnostic tools you can use.

LEARN ABOUT DIAGNOSING SYMPTOMATIC VMA

Is waiting the only option?

Waiting to treat symptomatic VMA may increase the risk that additional treatment may be less successful.5,7,11

  • Prolonged symptomatic VMA
  • Progressive loss of vision

Diagnostic tools

You have a key role in diagnosing symptomatic VMA before the condition progresses and causes potentially sight-threatening events. If patients complain of any symptoms you suspect are related to symptomatic VMA, it may be helpful to use these tools to aid early diagnosis.12

Amsler grid

The Amsler grid is a simple vision test that helps detect visual disturbances caused by changes in the retina, the macula, and the optic nerve.12 Instruct your patients to follow the instructions included on the grid.

DOWNLOAD THE AMSLER GRID
INSTRUCTIONS AND VISION TEST

Optical coherence tomography (OCT)

OCT is a noninvasive technique that uses light waves to visualize beyond the eye surface, allowing you to detect any disturbances in the eye.12 These images illustrate normal and abnormal OCT scans that you may see.

OCT of a Normal Eye

This OCT is from a patient who has undergone complete posterior vitreous detachment with no vitreous adhesion remaining on the macula.

OCT of a Patient with Symptomatic VMA

This OCT scan shows persistent attachment of the vitreous to the macula resulting in traction.

If the Amsler grid or OCT scan suggests that your patients have symptomatic VMA, take appropriate treatment action. Several treatment options are available that may help relieve your patients’ symptoms.

FIND OUT ABOUT SYMPTOMATIC VMA TREATMENT OPTIONS

Important Safety Information

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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. Data on file. ThromboGenics, Inc. 2015. 2. JETREA [package insert]. Iselin, NJ: ThromboGenics, Inc.; 2014. 3. 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. 4. Schneider EW, Johnson MW. Emerging nonsurgical methods for the treatment of vitreomacular adhesion: a review. Clin Ophthalmol. 2011;5:1151-1165. 5. Sonmez K, Capone A Jr, Trese MT, et al. Vitreomacular traction syndrome: impact of anatomical configuration on anatomical and visual outcomes. Retina. 2008;28:1207-1214. 6. Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol. 1995;119(1):55-61. 7. 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. 8. 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. 9. Smiddy WE, Michels RG, Glaser BM, deBustros S. Vitrectomy for macular traction caused by incomplete vitreous separation. Arch Opthalmol. 1988;106(5):624-628. 10. Metamorphopsia. The Free Dictionary website. Available at: http://medical-dictionary.thefreedictionary.com/metamorphopsia. Accessed on January 21, 2015. 11. Johnson MW. Perifoveal vitreous detachment and its macular complications. Trans Am Ophthalmol Soc. 2005;103:537-567. 12. American Macular Degeneration Foundation. Examinations. Available at: https://www.macular.org/examinations. Accessed February 13, 2015. 13. Prevent Blindness National. Symptomatic vitreomacular adhesion. Available at http://www.preventblindness.org/symptomatic-vitreomacular-adhesion. Accessed February 13, 2015. 14. Kaiser PK, Kampik A, Kuppermann BD, et al. Safety profile of ocriplasmin for the pharmacologic treatment of symptomatic vitreomacular adhesion/traction. Retina. 2015;35(6):1111-1127. 15. Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611-2619. 16. Stalmans P, Duker JS, Kaiser PK, et al. OCT-based interpretation of the vitreomacular interface and indications for pharmacologic vitreolysis. Retina. 2013;33(10):2003-2011.

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