Angioid Streaks

Angioid streaks are a rare eye disorder. They cause lines or streaks to appear in the retina. This happens because of breaks in Bruch’s membrane, a thin layer under the retina.

These streaks can cause vision problems if they hit the macula. The macula is the part of the retina that helps us see details clearly.

Several things can lead to angioid streaks. These include genetic disorders, eye trauma, and aging. Symptoms include blurry vision, blind spots, and bleeding in the retina.

To diagnose angioid streaks, doctors do a thorough eye exam. They also use imaging tests and look at your medical history.

There’s no cure for angioid streaks, but treatments can help manage the condition. Early detection and treatment are key to keeping vision sharp and quality of life high.

What are Angioid Streaks?

Angioid streaks are irregular, reddish-brown lines or streaks in the retina. This is the light-sensitive layer at the back of the eye. They happen when Bruch’s membrane, a thin tissue layer, breaks or cracks.

When Bruch’s membrane is damaged, it can show breaks. This lets the blood vessels under the retina show up as streaks. These streaks often start from the optic nerve head and can vary in size and number.

One big worry with angioid streaks is choroidal neovascularization (CNV). CNV happens when new blood vessels grow from the choroid into the retina through breaks in Bruch’s membrane. These new vessels can leak, causing retinal hemorrhage, swelling, and vision loss if not treated.

Angioid streaks can show up in one or both eyes and might not cause symptoms early on. But, as the condition gets worse, like with CNV, people might see vision problems, central vision loss, and lines that seem distorted.

Even though angioid streaks themselves don’t usually cause big vision problems, complications like CNV can. If not treated quickly, these can lead to serious vision loss. It’s important for people with angioid streaks to get regular eye checks to catch and manage any complications early.

Causes of Angioid Streaks

Angioid streaks happen when Bruch’s membrane weakens and cracks. This thin tissue layer is between the retina and the choroid. The main reasons include pseudoxanthoma elasticum, eye trauma, and genetic factors.

Pseudoxanthoma Elasticum

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder. It affects elastic fibers in the skin, blood vessels, and eyes. In the eyes, PXE makes Bruch’s membrane calcify and thicken, leading to cracks.

This damage is the main reason for angioid streaks in people with PXE.

Trauma to Bruch’s Membrane

Eye trauma, like a direct hit or injury, can break Bruch’s membrane. These breaks let choroidal blood vessels show through, seen as angioid streaks. The risk of getting angioid streaks from eye trauma depends on the injury’s severity and eye health.

Genetic Factors

Genetic disorders other than PXE also raise the risk of angioid streaks. These include:

People with a family history of angioid streaks or related genetic disorders are at higher risk. Regular eye exams can catch angioid streaks early. This allows for quick management and monitoring of any complications.

Symptoms of Angioid Streaks

People with angioid streaks may see their vision change. These changes can happen slowly and affect everyone differently. It’s important to notice these signs early and see a doctor quickly to keep your vision good.

Visual Disturbances

Visual problems are common in angioid streaks. You might see blurry or distorted images, making it hard to read or drive. Some people see straight lines as wavy, a condition called metamorphopsia.

Central Vision Loss

As angioid streaks get worse, you might lose central vision. This is because the macula, key for clear vision, gets damaged. It’s hard to read small text or thread a needle. You might also see a dark spot in your vision.

Metamorphopsia

Metamorphopsia makes objects look wrong. Straight lines seem wavy, and shapes are off. It’s a sign of angioid streaks and can make daily tasks hard.

If you notice these symptoms, see an eye doctor right away. Early treatment can slow the disease and save your vision. Your doctor will do a detailed eye exam and might do more tests to check your retinas.

Diagnosis of Angioid Streaks

Getting a correct diagnosis for angioid streaks is key to finding the right treatment. Doctors use several tools and methods to spot these eye lesions. These include fundoscopic exams, fluorescein angiography, and optical coherence tomography (OCT).

Fundoscopic Examination

The first step in diagnosing angioid streaks is a fundoscopic exam. An ophthalmologist uses an ophthalmoscope to look at the back of the eye. They look for reddish-brown or gray lines starting from the optic disc.

Fluorescein Angiography

Fluorescein angiography gives a closer look at the retinal blood vessels. A dye is injected into the blood, and photos are taken as it moves through the vessels. This method shows where the dye leaks, highlighting the streaks.

Optical Coherence Tomography (OCT)

OCT is a non-invasive way to see the retina in detail. It uses light to create detailed images of the retina. OCT scans help see angioid streaks and check the retina’s health over time.

The table below shows the main points of these diagnostic methods:

By using these tools together, doctors can accurately diagnose angioid streaks. They can then create a treatment plan that fits each patient’s needs.

Complications Associated with Angioid Streaks

People with angioid streaks may face serious vision problems. One major issue is choroidal neovascularization. This happens when blood vessels grow under the retina, causing fluid leaks and scarring. If not treated, it can lead to quick and permanent vision loss.

Another problem is subretinal fibrosis. It’s when scar tissue forms under the retina. This scar tissue can harm the retina layers, causing permanent vision loss. Treating subretinal fibrosis is hard and may need advanced treatments.

Those with angioid streaks are also at risk for age-related macular degeneration (AMD). AMD affects the macula, the part of the retina for sharp vision. As AMD gets worse, it can make daily tasks like reading or seeing faces hard.

Because of these risks, it’s important for people with angioid streaks to see an eye doctor often. Catching and treating problems like choroidal neovascularization, subretinal fibrosis, and AMD early can help save vision. This can improve their quality of life.

Treatment Options for Angioid Streaks

There’s no cure for angioid streaks, but treatments can manage symptoms and slow vision loss. The right treatment depends on how severe the condition is and if there are any complications. Main options include laser photocoagulation, anti-VEGF therapy, and photodynamic therapy (PDT).

Laser Photocoagulation

Laser photocoagulation uses a high-energy laser to seal off leaking blood vessels in the retina. It helps prevent further vision loss by reducing bleeding and scarring. It’s often recommended for patients with CNV caused by angioid streaks.

Anti-VEGF Therapy

Anti-VEGF therapy involves injecting medications like bevacizumab (Avastin), ranibizumab (Lucentis), or aflibercept (Eylea) into the eye. These drugs stop the growth of abnormal blood vessels by targeting VEGF. It’s shown to be effective in managing CNV linked to angioid streaks.

Photodynamic Therapy (PDT)

Photodynamic therapy (PDT) is a two-step treatment. It uses a light-sensitive drug called verteporfin (Visudyne) and a low-energy laser. The drug is injected and accumulates in abnormal blood vessels. When the laser is applied, it activates the drug, closing off the vessels. PDT is an effective option for treating CNV in patients with angioid streaks.

The success of these treatments can vary. Sometimes, a mix of therapies is recommended. Regular check-ups with an eye care professional are key to monitoring treatment success and making adjustments as needed.

Prognosis and Long-term Outlook

The outlook for people with angioid streaks varies based on several factors. These include the cause, how severe it is, and if complications like choroidal neovascularization happen. Angioid streaks themselves usually don’t cause big vision problems. But, if choroidal neovascularization develops, it can lead to serious vision loss if not treated.

Research shows that 72% to 86% of people with angioid streaks will get choroidal neovascularization at some point. The risk goes up with age:

It’s important to catch choroidal neovascularization early and treat it quickly. Regular eye exams, including fundoscopy and OCT imaging, can spot problems early. This makes treatments more effective.

With the right care, many people with angioid streaks can keep their vision good for a long time. But, because the conditions can get worse, ongoing care is key. Working with a skilled ophthalmologist and retina specialist is important. They can help manage the condition and improve quality of life.

Coping with Angioid Streaks

Getting a diagnosis of angioid streaks can feel overwhelming. But, there are ways to deal with it and keep living well. Low vision aids and support groups are key resources for those with angioid streaks.

Low Vision Aids

Low vision aids help people with angioid streaks use what vision they have. They include magnifying glasses, electronic magnifiers, and software that makes text bigger on computers. A low vision specialist can help find the best aids for each person.

Support Groups

Being part of a support group for angioid streaks or related conditions is helpful. It offers a sense of community and emotional support. People can share their experiences, tips, and the latest research and treatments.

Support groups can be in-person or online. They let people connect with others who face similar challenges. By using low vision aids and joining support groups, people with angioid streaks can handle the condition better. It’s important to work with healthcare professionals and get support from loved ones too.