History

61-year-old male presents for eye examination. He states that his vision has been hazy centrally in the left eye for about 2 weeks.

Medical History

Healthy with no history of diabetes mellitus or hypertension

Examination

• Best – corrected vision: OD: 20/20, OS: 20/60
• Pupils: Round and reactive with no APD
• Motility: Full OU
• Intraocular pressures: Normal OU
• Slit lamp examination: Significant for PCIOL, OU.

Fundus Examination

• See Pictures below

Ancillary Tests

• Fluorescein Angiogram:

Diagnosis

Angioid Streaks

Linear narrow subretinal brownish streaks that radiate from the optic nerve towards the macula and nasal retina. They represent full-thickness breaks in Bruch’s membrane with disruption of the underlying choriocapillaris and overlying RPE. They tend to appear in the second decade, usually bilateral and can have systemic association in 50% of the cases. The most common systemic associations are Pseudoxanthoma elasticum, Ehlers-Danlos syndrome, Paget’s disease, and Sickle cell. 50% of the cases are idiopathic.

Patients with angioid streaks are usually asymptomatic. They can be complicated by subretinal choroidal neovascularization causing sudden vision loss. Thermal focal laser as well as Photodynamic therapy have been used for treatment of associated CNV. There seems to be a high recurrence rate following either procedure.