Angioid streaks: Description, Causes and Risk Factors:Angioid streaks: ASAngioid streaks are visible irregular crack-like dehiscence in Bruch's membrane that are associated with atrophic degeneration of the overlying retinal pigmented epithelium. Angioid streaks may be associated with pseudoxanthoma elasticum, Paget's disease, sickle-cell anemia, acromegaly, Ehlers-Danlos syndrome, and diabetes mellitus, but also appear in patients without any systemic disease.For several years the appearance of angioid streaks in sickle-cell hemoglobinopathies was attributed to high level of serum iron. However, other types of anemias with increased iron levels in blood are not associated with angioid streaks. In addition, histochemical and EM studies, which took place in the eyes of patients with homozygotic sickle-cell anemia demonstrated severe tissue calcification; this fact favors the hypothesis that angioid streaks in patients with sickle-cell hemoglobinopathies are correlated to calcium deposition at Bruch's membrane.Patients with AS are generally asymptomatic, unless the lesions extend towards the foveola or develop complications such as traumatic Bruch's membrane rupture or macular choroidal neovascularization (CNV). The visual prognosis in patients with CNV secondary to angioid streaks, if untreated, is poor and most treatment modalities, until recently, have failed to limit the devastating impact of CNV in central vision. However, it is likely that treatment with antivascular endothelial growth factor, especially in treatment-naive eyes to yield favorable results in the future and this has to be investigated in future studies.Angioid streaks usually look like linear dark red or gray lines beneath the retina and retinal blood vessels. The streaks ring the optic nerve about 25% of the time and radiate out from the optic nerve about 75% of the time.Symptoms:Visual acuity is normal unless a leakage, bleeding, or Bruch membrane dehiscence involves the central macula. Distorted central vision (metamorphopsia) and micropsia can be early signs of macular involvement.There are irregular dark red steaks radiating from the optic nerve head. They lid beneath the retina and the blood vessels. The macula may show scarring or pigmentary hyperplasia from subretinal neovascular membrane.Look for associated sign:Optic disc drusen.Look for systemic diseases:Pseudoxanthoma elasticum. This is the most common skin condition seen in the MRCOphth examination. There are soft, wrinkled, yellow xanthoma -like skin lesions commonly seen in the neck.
Ehlers-Danlos syndrome (poorly healed scars at the knees or heels).
Diagnosis:The diagnosis of AS is usually made on the basis of fundoscopy, but intravenous fluorescein angiography can help to delineate the presence of the disease when the ophthalmoscopic appearance is subtle.Angioid streaks are mainly asymptomatic. The appearance of symptoms occurs when the AS involve the foveola or in case of choroidal neovascularization (CNV) in the macular region.Indocyanine Green (ICG) angiography is a useful diagnostic tool for angioid streaks only in the rare case that fundoscopy and fluorescein angiography can not confirm the diagnosis.Treatment: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.Unfortunately, it is impossible to make ASgo 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, which may involve the use of a laser to halt progression. Surgical removal of neovascular nets is also a treatment choice, as well as photodynamic therapy.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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