Angioid Streaks

What are angioid streaks?

Angioid streaks are jagged lines underneath your retina. They don’t usually cause symptoms, but your eye care specialist can see the blood vessel-like streaks during an eye exam. People who get angioid streaks usually have them in both eyes. You may also hear them called Knapp streaks or Knapp striae.

Angioid streaks point outward from your optic disc (the last part of the optic nerve before your brain). They happen when there are tears in tissue called Bruch’s membrane, the inside lining of your choroid between your retina and your sclera (the white of your eye). Your choroid contains vessels that allow blood and nutrients to flow through your eye.

What are the symptoms of angioid streaks?

Angioid streaks typically don’t cause symptoms. But complications related to angioid streaks could cause vision loss.

What causes angioid streaks?

Angioid streaks happen because of splits in Bruch’s membrane. In some people, the membrane can become thick and prone to cracking. In some cases, eye injuries can cause them.

What are the risk factors for angioid streaks?

Angioid streak risk factors include certain other health conditions, including a list that you can remember by thinking of the acronym PEPSI:

• Pseudoxanthoma elasticum. This inherited disease causes mineral buildup in your body’s elastic fibers. It’s the most common condition associated with angioid streaks.
• Ehler-Danlos syndrome.
• Paget’s disease of the bone.
• Sickle cell disease.
• Idiopathic (spontaneous or with no known cause) conditions that affect the hemoglobin in your blood or your collagen. Hemoglobin is part of your red blood cells. Collagen is a building block for your connective tissue.

Other risk factors for angioid streaks include:

• Aging.
• Eye injury.

What are the complications of angioid streaks?

Possible complications of angioid streaks that can distort or reduce your vision include:

• Invasive new blood vessels growing in your retina, called choroidal neovascularization.
• Bleeding under your retina, called a subretinal hemorrhage.

How are angioid streaks diagnosed?

An eye care specialist will give you an eye exam. While this may be enough for your provider to suspect angioid streaks, you’ll likely have other tests. These will help with diagnosing angioid streaks, systemic diseases (diseases that affect your whole body) and complications of angioid streaks. Your provider may have you repeat these tests to watch your condition over time.

What tests will be done to diagnose angioid streaks?

Providers may perform one or more of these imaging tests:

• Fluorescein angiography: This test uses an injected dye to make the blood vessels in your eyes more visible.
• Optical coherence tomography (OCT): This test uses reflected light to take pictures of your eyes.
• Fundus autofluorescence: This test uses a substance already in your body — lipofuscin — to show changes in your eye.

How are angioid streaks treated?

There’s no treatment for angioid streaks. But your provider may need to treat complications or other conditions related to angioid streaks.

Specific medications and treatments for angioid streak complications

If you have new and unruly blood vessels, your provider might suggest:

• Photocoagulation, which uses lasers to destroy unwanted blood vessels.
• Photodynamic therapy (PDT), which combines light energy and photosensitizing medicines to treat the vessels.
• Anti-vascular endothelial growth factor (anti-VEGF) medications. Your provider injects anti-VEGF medications into the vitreous humor of your eye to control vessel growth. Another name for these intravitreal medicines is VEGF inhibitors. You’ll likely need repeated injections.
• Combining PDT and anti-VEGF medications.

Complications/side effects of treatments for angioid streaks

• Laser photocoagulation may give you clearer vision in the short term, but it may have the unintended effect of destroying tissue. Complications can include retinal bleeding and loss of central vision.
• Side effects of anti-VEGF medications are usually short-lived and include eye pain, irritation, discharge and seeing floaters or specks. There’s also a very low chance of a serious eye infection following each injection.
• Side effects of PDT include a temporary increased risk of sunburn and the possible creation of a blind spot. Complications of PDT include allergic reactions to photosensitizing medicines and, rarely, the creation of more unruly blood vessels.

Can angioid streaks be prevented?

You can’t prevent angioid streaks that happen because of conditions that affect your whole body. You may be able to avoid angioid streaks that happen because of eye injuries.

How can I lower my risk?

You may lower your risk of developing angioid streaks from eye injuries by wearing protective eye gear when you’re:

• Working around machinery or things that can fly up and hit your eye.
• Riding a motorcycle.
• Participating in rougher types of sports.
• Doing yard work.

What can I expect if I have angioid streaks?

Angioid streaks by themselves aren’t dangerous. If you have an eye injury, you should see an eye care provider for treatment. If you have angioid streaks due to systemic conditions, you should follow your healthcare provider’s treatment suggestions for the condition and any needed therapy for your eyes.

When should I see my healthcare provider?

You should see an eye care provider for regular appointments. If you have an eye condition or a disease that can affect your eyes, you may need more frequent appointments.

If you have any issues with your eyes, including eye pain or changes in vision, see an eye care provider.

You should contact your provider or go to an emergency room if you:

• Have an eye injury.
• Have extreme pain or bleeding in your eye.
• Experience a sudden loss of vision.

What questions should I ask my doctor about angioid streaks?

You may want to ask your healthcare provider some questions, including:

• Why do I have angioid streaks?
• What type of treatment do I need?
• What are the side effects of these treatments?
• How often should I have appointments with you?
• What other providers do I need to see?
• What new or worsening symptoms should I look out for?
• What’s my prognosis (outlook)?

What is the difference between lacquer cracks and angioid streaks?

Both lacquer cracks and angioid streaks show up as lines in your eyes during an examination, but they tend to look different and are caused by different things.

Lacquer cracks happen in the eyes of people who are very nearsighted (myopic). Angioid streaks happen because of certain diseases that affect your eyes or from damage to your eyes.

Your provider may need to use imaging tests to tell the difference between the two conditions if the appearance of the lines isn’t clear.

A note from Cleveland Clinic

If you have angioid streaks, you probably won’t know. Your provider may find them during a regular eye exam. In many cases, there’s nothing more to do except monitor them. In other cases, your provider may suspect you have a contributing condition. In that case, you might have additional tests. Be sure to ask your provider to be clear about what tests you’re having and what the results mean. Your healthcare team is there to support you and help you make decisions.