Angioid Streaks

Overview

Angioid streaks are thin, crack-like lines in a layer of tissue behind the retina, called Bruch's membrane. The retina is the light-sensitive part of the eye. These lines can look like blood vessels, but they are actually breaks in the membrane. Over time, they may allow abnormal blood vessels to grow into the retina, which can affect vision.

No — angioid streaks are rare. Most eye doctors will see few, if any, cases in their career.

Angioid streaks usually develop in adulthood, most commonly between the ages of 30 and 60. They can affect anyone, but they are much more likely to occur in people with certain inherited or blood conditions.

Symptoms

Common symptoms

• No symptoms at all, especially when the streaks do not involve the center of the retina
• Blurred or slightly distorted central vision
• Straight lines appearing wavy or bent
• Sudden visual loss if blood leaks from new vessels

Causes

Main causes

• Bruch's membrane becomes brittle and develops tiny breaks
• Most cases are linked to an inherited condition called pseudoxanthoma elasticum (PXE)
• Other conditions including Paget's disease of bone, sickle cell disease, or certain blood disorders can also be associated
• Sometimes no underlying cause can be found

Risk factors

• A family history of PXE or similar elastin-related conditions
• Paget's disease of bone or sickle cell disease
• Repeated minor trauma to the eye
• Inherited blood vessel abnormalities

When to see a doctor

See a doctor urgently if:

• If you have sudden vision loss, new distortion, or an eye injury that changes your vision, seek immediate care.

Book a routine appointment if:

• If you have a condition known to be linked with angioid streaks, or a family history, ask for a dilated eye examination at least once a year.

Diagnosis

An eye doctor can usually see angioid streaks during an eye examination after dilating (widening) your pupils. They appear as reddish-brown or dark lines that radiate from the optic disc. Because they can be linked to other conditions, the doctor may ask for blood tests or a skin sample.

Tests that may be done

• Dilated fundus examination — looking at the back of your eye after dilating eye drops
• Optical coherence tomography (OCT) — a quick, painless scan that shows the layers of the retina
• Fluorescein angiography — a dye injected into your arm to photograph blood vessels in the retina
• Blood tests or skin biopsy to identify an underlying condition

What to expect at your appointment

The examination usually takes about 30 to 60 minutes. Your eyes may be sensitive to light for a few hours, and reading may be blurry until the dilation wears off. You may be asked to arrange a lift home. The eye doctor will explain what they see and discuss next steps in clear terms.

Treatment

Treatment for angioid streaks focuses on managing complications, not curing the streaks themselves. The most important step is regular monitoring so that any abnormal vessel growth or leak can be caught early. If bleeding or fluid builds up in the macula (the centre of the retina), prompt treatment can protect your sight.

Self-care at home

• Wear protective goggles or glasses during sports, DIY, or any activity where an object could hit your eye.
• Use an Amsler grid if your doctor gives you one — it helps you notice small changes in vision.
• Avoid eye rubbing — it may increase the risk of tissue damage.
• Keep up with your diabetes and blood pressure checks, because these can affect eye health.

Medical treatments

The main medical option is injections into the eye of a medicine that suppresses abnormal blood vessel growth (often called anti-VEGF therapy). These injections are usually given every few weeks or months, depending on the response. Less commonly, laser treatment may be applied to stop bleeding vessels. Photodynamic therapy, which uses a light-sensitive medication and a cold laser, is another option. Your ophthalmologist will recommend a plan based on the exact location of the problem. These treatments are usually done in an outpatient clinic with numbing drops and are not painful, though you may feel slight pressure.

When is surgery considered?

Surgery is rarely used for angioid streaks. However, if significant bleeding collects in the vitreous (the gel in the eye), a procedure called a vitrectomy may be needed to remove the blood and allow a clear view of the retina.

Living with this condition

Living with angioid streaks means being careful with your eyes and keeping track of any visual changes. You can still work, travel, and enjoy hobbies with the right support. Your eye clinic can help you adapt if your central vision becomes affected.

Lifestyle tips

• Wear UV-protective sunglasses outdoors.
• Use protective eyewear for high-risk activities.
• Avoid contact sports that involve high impact, if your doctor advises.
• Keep a printed or digital Amsler grid at home and check it weekly.

Diet and exercise

A healthy diet with plenty of green leafy vegetables, fruits, and omega-3-rich fish supports general eye health. Gentle exercise such as walking, swimming, or cycling is safe for most people, but if you take an anticoagulant or have a bleeding disorder, check with your doctor before starting new activities.

Mental health and emotional wellbeing

A diagnosis of angioid streaks can bring worries about eventual sight loss. It's normal to feel stressed or anxious. You can ask your eye care team about counselling, and remember that you are in control — by attending check-ups and reporting changes, you are actively protecting your vision.

Prevention

You cannot prevent the streaks from developing, but you can reduce the risk of serious vision loss by attending regular eye examinations, wearing eye protection, and reporting any new visual symptoms without delay.

Screening programmes

If you have a first-degree relative (parent, sibling, child) with pseudoxanthoma elasticum or another condition linked to angioid streaks, ask your doctor about genetic counselling and regular eye screening.

Complications

If left untreated

• New blood vessels may grow under the retina (choroidal neovascularisation) and leak fluid or blood
• Bleeding under the retina can lead to sudden, permanent central blindness
• In rare cases, a whole section of the retina may detach, requiring emergency surgery

Long-term outlook

With today's treatments and careful monitoring, most people retain useful vision for many years. Even if complications do occur, medicines injected into the eye can often stabilise the condition, and low-vision rehabilitation can help you continue doing what you enjoy. An early diagnosis and regular care are the best tools for a positive future.

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