Treating Angioid Streaks

Angioid streaks are a retinal condition characterized by breaks and cracks in Bruch’s membrane, the lower layer of the retina that helps feed and nourish the overlying photoreceptor layer.  Bruch's membrane can thicken, calcify and begin to crack. The cracks appear as thick, brown or grayish lines that radiate from the area around the optic nerve. These breaks can cause disease processes similar to macular degeneration.

Angioid streaks are a bilateral, symmetric finding, usually appearing as radiations that appear to emanate from the area around the optic nerve. Broad at their base, they taper at their ends.

Eye doctor examining senior womans vision
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Who Is at Risk for Angioid Streaks?

Although angioid streaks can occur without a systemic cause, most cases are associated with elastic tissue diseases. Up to 50% of people with angioid streaks have either pseudoxanthoma elasticum, Paget’s disease or Ehlers-Danolos syndrome.

  • Pseudoxanthoma elasticum (PXE) is a disease where deposits of calcium and minerals accumulate in elastic fibers in the body. This can affect the skin, eyes, cardiovascular system, and gastrointestinal system. Elastic fibers are a component of connective tissue that provides flexibility and strength in our bodies. 
  • Paget's disease is a condition characterized by the bone deformity that is caused by an interruption in the process of bone regeneration and bone begins to be replaced at a faster rate than normal. Bones can become enlarged and weak.
  • Ehlers-Danlos syndrome is a rare genetic disorder that affects the collagen in our body. People with Ehlers-Danlos can have several different eye problems including keratoconus, high myopia, retinal detachment, lens dislocation, and angioid streaks.

The common mnenomic PEPSI can help recall those at risk for angioid streaks:

  • Pseudoxanthoma Elasticum
  • Ehlers Danlos Syndrome
  • Pagets Disease
  • Sickle Cell and other hemoglobin related disorders
  • Idiopathic (no known cause)

Why Do Angioid Streaks Cause Vision Loss?

When breaks occur in the lower retinal layers, the layers can no longer properly nourish the photoreceptor cells. This results in leakage of fluid and a lack of oxygen. Choroidal neovascular nets (a fine mesh of blood vessels and fibrous tissue) then begin form. These nets can cause more hemorrhaging and scarring in the macula. This formation is similar to what sometimes occurs with macular degeneration. Significant vision loss can occur.


Unfortunately, it is impossible to make angioid streaks go away. Annual eye examinations should be performed by an optometrist or general ophthalmologist to check for the development of neovascular nets and other associated signs. If they occur, you will be referred to a retinal specialist for treatment. In this case, new drugs called antivascular endothelial antibodies are used and have shown great success. Other patients may be treated with anti-vascular endothelial growth factor (VEGF) drugs, along with widely used with choroidal fibrovascular "nets" and have also shown positive results. These drugs are injected directly into the eye. While these newer drugs work well, they often have to be injected repeatedly as neovascularization often reoccurs in patients with angioid streaks.

What You Should Know About Angioid Streaks

People with angioid streaks have a fragile eye, placing them at higher risk for choroidal rupture and subretinal hemorrhage if they undergo eye trauma. Therefore, eye protection is a must. Polycarbonate lenses should be prescribed as they are the most impact-resistant lens material. Special safety goggles should be worn during contact sports.

1 Source
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  1. American Academy of Opthalmology. Eye Wiki. Angiod Streaks.

Additional Reading
  • Alexander, Larry J. Primary Care of the Posterior Segment, Second Edition. Appleton & Lange, 1994, pp 300-301.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.