1880 Sismet Road Mississauga, ON L4W 1W9, Canada


Angioid streaks refer to a pattern of radiating folds or cracks originating from the optic nerve of patients below the retina. The presence of angioid streaks cannot be ignored because it has the potential to lead to retinal complications which may cause long term vision loss. In addition, angioid streaks may signify the presence of another disease within the patient’s body.


Angioid streaks are small cracks in the Bruch’s membrane which underlies the retina and separates the retina from the choroid, a tissue layer found beneath the retina. Bruch’s membrane physically separates the retina and choroid and ensures that no large molecules cross from the choroid to the retina. Thus, angioid streaks or breaks in the Bruch’s membrane may lead to complications in the retina. Eventually, angioid streaks can cause retinal distortion, the formation of scotomas, or blind spots, and the progressive loss of central vision.


The presence of angioid streaks is associated with many diseases, including pseudoxanthoma elasticum (PXE), Ehlers-Danlos syndrome, Marfan’s syndrome, sickle cell disease, and Paget’s disease to name a few. It is therefore important that patients who have angioid streaks tell their general practitioners in order to further investigate their systemic condition.


With respect to the ocular manifestation of this disease, it is limited to the posterior segment where the cracks extending from the optic nerve can lead to both direct and indirect problems. For example, the cracks themselves can lead to visual distortion if they extend through the macular region.

Further complications associated with angioid streaks include the development of abnormal choroidal neovascular membranes. In short, this condition leads to the formation of abnormal blood vessels which grow from the choroid and through the cracks in Bruch’s membrane into the retina. The fragility of these blood vessels makes them susceptible to bleeding in the retina while their swollen shapes tear and cover the retina. As a result, there can be severe visual distortion and loss and even fibrotic membrane development or excessive fibrotic tissue growth in the central macular region from the optic nerve.

A key symptom of angioid streaks in association with fibrotic tissue growth from the optic membrane is the formation of dark snake like streaks extending from the optic nerve to the retina. This occurs because the penetration of the fibrotic tissues through the choroid and then angioid streaks allows them to put pressure on retinal blood vessels causing them to become darker in color. The specific identification of this symptom may be difficult due to racial pigmentation and thus your physician may use fluorescein angiography along with autofluorescence to identify and monitor the progression of these streaks. The development of abnormal choroidal neovascular membranes will also be checked using the aforementioned image technologies.

Image of a retina with angioid streaks
Illustration of the layers in the back of the eye, including Bruch’s membrane
Image of a retina with angioid streaks indicated by green arrows and peau d’orange shown by white arrows.

Another symptom arising from angioid streaks is spots of “peau d’orange,” or orange peel skin, in the peripheral retina. While patients with peu d’orange can have angioid streaks, this symptom is also associated with other eye diseases.


The current treatments for patients with angioid streaks can be separated into those treating the systemic disease and those treating the ocular findings. Due to the high association between patients with angioid streaks and other systemic diseases, the management of the systemic diseases are best left to the medical practitioners who are involved in your care, such as internal medicines specialist or other family practitioners who may be specialized in managing your care.


In the case of ocular complications, the development of abnormal choroidal neovascular membranes is the most severe symptom of angioid streaks. The most effective treatment for this condition is the intraocular injection of anti-VEGF (anti vascular endothelial growth factor), which is used to treat the same symptom in the wet form of age-related macular degeneration. Patients with angioid streaks tend to respond more quickly to the use of intraocular injections of anti-VEFG medications and may not need as many injections as patients who have age-related macular degeneration because patients with age-related macular degeneration have widespread and diffused disease of their Bruch’s membrane. If a patient is unable to use anti-VEGF, for example if she is pregnant, steroid medications may be injected intraocularly instead. Additionally, patients may be asked to refrain from physical contact sports to minimize the risk of extending their choroidal fractures and angioid streaks.


Other novel treatment options include the use of PDT (photodynamic therapy) and even new radiation technologies. With that said, these technologies have not been proven and, in fact, anti-VEGF injections remain the best treatment option. Another recommendation made to patients who have angioid streaks is to avoid physical contact sports in which there is a high risk of trauma, as this will reduce the risk of developing or extending their choroidal fractures.


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are available at two convenient locations

1880 Sismet Road Mississauga,
ON L4W 1W9, Canada

+1 905-212-9482

2630 Rutherford Rd #105, Vaughan,
ON L4K 0H2, Canada

+1 (905) 212-9482

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