VMA vs VMT

Entity	OCT-based definition	Additional features	Symptom	Corresponds to full thickness macular hole (FTMH) stage:
Vitreomacular adhesion (VMA)	The following must be present on at least one OCT B-scan image: (i) Partial vitreous detachment as indicated by elevation of cortical vitreous above the retinal surface in the perifoveal area (ii) Persistent vitreous attachment to the macula within a 3-mm radius from the center of the fovea (iii) Acute angle between posterior hyaloid and inner retinal surface (iv) Absence of changes in foveal contour or retinal morphology	None	None	Stage 0 (Other eye should have full thickness macular hole)
Vitreomacular traction (VMT)	The following must be present on at least one OCT B-scan image: (i) Partial vitreous detachment as indicated by elevation of cortical vitreous above the retinal surface in the perifoveal area (ii) Persistent vitreous attachment to the macula within a 3-mm radius from the center of the fovea (iii) Acute angle between posterior hyaloid and inner retinal surface (iv) Presence of changes in foveal contour or retinal morphology (distortion of foveal surface, intraretinal structural changes such as pseudocyst formation, elevation of fovea from the retinal pigment epithelium (RPE), or a combination of any of these three features) (v) Absence of full thickness interruption of all retinal layers	Foveal pseudocyst, macular thickening, retinal capillary leakage (typically isolated VMT alone does not cause leak on fluorescein angiography), macular schisis, cystoid macular edema, retinal detachment	Reduced or distorted vision	Stage 1 (VMT only, i.e. impending macular hole) OR Stage 2 (VMT with small/medium FTMH) OR Stage 3* (VMT with medium/large FTMH)

 

Entity	OCT-based classification
Vitreomacular adhesion (VMA)	(i) Focal: Width of attachment ≤1500 μm (ii) Broad: Width of attachment >1500 μm
	(i) Concurrent: Associated with other macular abnormalities (e.g. age-related macular degeneration, retinal vein occlusion, diabetic macular edema) (ii) Isolated: Not associated with other macular abnormalities
Vitreomacular traction (VMT)	(i) Focal: Width of attachment ≤1500 μm (ii) Broad: Width of attachment >1500 μm
	(i) Concurrent: Associated with other macular abnormalities (e.g. age-related macular degeneration, retinal vein occlusion, diabetic macular edema) (ii) Isolated: Not associated with other macular abnormalities

With age, the vitreous gel undergoes liquefaction forming pockets of fluid within the vitreous (synchysis) which leads to a contraction or condensation (syneresis) of the vitreous. With loss of vitreous volume, there is a tractional pull exerted at sites of vitreoretinal and vitreopapillary attachments by means of the condensing dense vitreous cortex.

At the same time, there is weakening of these attachments between the vitreous and the internal limiting membrane (ILM) and it is proposed that detachment of the posterior hyaloid proceeds in the following sequence:

(i) Perifoveal region (possibly, temporal followed by nasal)

(ii) Superior and inferior vascular arcades

(iii) Fovea

(v) Mid-peripheral retina

(vi) Optic disc (when vitreous is detached fully from the optic disc, commonly associated with the Weiss ring, it is called a complete PVD)

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