Abstract: Angioid streaks are a rare ophthalmic finding characterized by breaks in Bruch’s membrane and subsequent streak-like alterations in the fundus. This article provides a comprehensive review of angioid streaks, including their etiology, clinical features, diagnostic modalities, management strategies, and recent advancements in research and treatment. By enhancing understanding of angioid streaks, ophthalmologists can improve patient care and outcomes.

Introduction: Angioid streaks are linear breaks in Bruch’s membrane, which serve as conduits for choroidal neovascularization (CNV) and can lead to vision-threatening complications such as macular hemorrhage and subretinal fibrosis.

Etiology: Angioid streaks are associated with various systemic conditions, including pseudoxanthoma elasticum (PXE), Ehlers-Danlos syndrome, and Paget’s disease of bone. These conditions predispose individuals to calcification and fragmentation of Bruch’s membrane, resulting in the characteristic streak-like appearance on fundus examination.

Clinical Features: Angioid streaks typically manifest as reddish-brown linear lesions radiating from the optic disc. Associated findings may include optic disc drusen, subretinal hemorrhages, and CNV membranes. Visual symptoms vary depending on the presence of complications such as CNV-related macular edema or subretinal fibrosis.

Diagnostic Modalities: Diagnosis of angioid streaks relies on clinical examination, fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT), and, in some cases, indocyanine green angiography (ICGA). FA reveals characteristic hyperfluorescence corresponding to the breaks in Bruch’s membrane, while OCT allows for visualization of associated macular changes.

Management Strategies: Management of angioid streaks aims to prevent vision loss and manage complications such as CNV. Treatment modalities include intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, photodynamic therapy (PDT), and submacular surgery for subfoveal CNV. Additionally, systemic management of underlying systemic diseases may be necessary to prevent disease progression.

Recent Advancements: Recent advancements in the management of angioid streaks include the use of novel anti-VEGF agents with extended duration of action, as well as the exploration of combination therapies targeting multiple pathways involved in CNV formation. Emerging therapies targeting the calcification process in Bruch’s membrane may offer new avenues for treatment.

Conclusion: Angioid streaks represent a rare but clinically significant ophthalmic finding associated with systemic diseases and vision-threatening complications. Through early diagnosis, appropriate management, and ongoing research, ophthalmologists can optimize outcomes for patients with angioid streaks.

For further reading and reference:

• American Academy of Ophthalmology (AAO): https://www.aao.org/
• National Organization for Rare Disorders (NORD): https://rarediseases.org/