Angioid Streaks

Angioid streaks are found in the Bruch’s membrane (the layer separating the choriocapillaris from the retinal pigment epithelium) and radiate outward from the optic disc in the shape of irregular linear crack or splits that look like a partially broken window pane. The cracks and splits may lead to a disciform type of macular degeneration. Decreased vision may result from choroidal and subretinal neovascularization. If the patient is highly myopic, the streaks may appear with a tilted disc and peripallary atrophy, as well as macular degeneration may be present in their history. Of note, angioid streaks are associated with increased risk of GI bleeds and cardiovascular complications.

Angioid streaks are found in several different conditions, among them:

  1. pseudoxoanthoma elasticum (PXE), Gronblad-Strand-Berg-Syndrome (lose skin on the neck and elbow),
  2. osteitis disformans (Paget’s disease), (bone pain and hearing loss),
  3. sickle cell anemia,
  4. senile elastosis of the skin,
  5. hypertensive cardiovascular disorders, and
  6. fibrodysplasia hyperelastica (Ehlers-Danlos-Syndrome).

By far, the most common cause is PXE.

If treatable, extrafoveal choroidal neovascular membranes would be taken care of by focal laser treatment. Other diagnostic options would be skin biopsy, cardiovascular evaluation, serum alkaline phosphatase, urine screen, calcium screen, and possibly a sickle cell work-up. The patient should be instructed on the usage of an Amsler grid on a daily basis with the understanding that any changes in the daily findings should be evaluated by a professional immediately. Fundus examinations should be conducted periodically to observe for development of choroidal neovascularization, which can be treated similar to the treatment of subretinal neovascular membranes in age related macular degeneration.