Do you see streaks like this inside your eyes? Let's talk about Angioid Streaks!

Have you ever been to an eye doctor and heard something like, "You can see these little lines inside your eye, we call them Angioid Streaks"? Or have you just heard this name? You might be a little scared to hear this. But don't worry. Today, we're going to talk about this condition called Angioid Streaks in a simple, understandable way.

Do you know what Angioid Streaks are?

Simply put, Angioid Streaks are tiny, rough lines that appear under the retina of your eye. They look like blood vessels, but they are not actually blood vessels. They are usually seen when your eye doctor examines your eyes. They can often be seen in both eyes. Some people also call them Knapp streaks or Knapp striae.

Imagine, inside your eye there is an `Optic Disc` (that is, the last part of the optic nerve before it connects to the brain), and these streaks appear to extend outward from there. They are formed when a tissue called `Bruch's membrane` develops inside the eye. This `Bruch's membrane` is the inner covering of the `Choroid` (this is where the blood vessels that bring blood and nutrients to the eye are located). It is located between the `Retina` and the `Sclera`.

What are the symptoms of this condition?

Most of the time, there are no symptoms of angioid streaks. This means that you may not notice any changes or discomfort. However, some complications associated with these angioid streaks can sometimes lead to vision loss. That is why doctors are concerned about this.

Why do these angioid streaks form?

The main reason is the formation of cracks in the `Bruch's membrane` that we talked about earlier. In some people, this membrane thickens over time, deposits things like calcium, and becomes easily brittle. That's when these streak-like cracks form.

Sometimes, these can also be caused by eye injuries.

What are the risk factors?

There are some health conditions that can cause Angioid Streaks. To keep these in mind, doctors sometimes use the acronym PEPSI . Let's see what they are:

• P - Pseudoxanthoma elasticum: This is a hereditary disease. It is caused by the deposition of minerals in the elastic fibers of the body. This disease is most commonly associated with Angioid Streaks.
• E - Ehlers-Danlos syndrome: This is also a genetic condition that affects the body's connective tissues.
• P - Paget's disease of the bone: This is a disease that affects the bones. It affects the way new bones form and break.
• S - Sickle cell disease: This is an inherited disease that affects the red blood cells. The red blood cells become deformed and can become trapped in the blood vessels.
• I - Idiopathic conditions: These are conditions for which no specific cause can be found . These can affect the hemoglobin (part of your red blood cells) or collagen (a key component of connective tissue) in your blood.

The important thing is, you don't have to have every disease that PEPSI says to develop Angioid Streaks. These are the main diseases that can be associated.

Other risk factors

In addition to these major medical conditions, several other factors may increase the risk of developing Angioid Streaks:

• Aging: Changes in Bruch's membrane can occur with age.
• Eye injuries: As we mentioned earlier, these can also be caused by things like severe blows to the eyes.

What are the possible complications of Angioid Streaks?

Although angioid streaks are usually harmless, sometimes they can cause complications that affect your vision. These are the ones that are dangerous.

There are two main complications:

1. Choroidal neovascularization: This is when new, unhealthy blood vessels grow in the retina. These are like weeds, and they are not good for the eye. They can bleed or leak fluid, causing blurred vision and distortion.

2. Subretinal hemorrhage: These newly formed weak blood vessels can rupture and bleed under the retina. This can also damage vision.

It is only when complications like these arise that your vision begins to become distorted or even decrease.

How is this diagnosed? What tests are done?

Most of the time, your eye doctor can detect these angioid streaks during a routine eye exam. However, to confirm the condition, rule out other conditions, and determine if there are any complications, your doctor may want you to have more tests. Sometimes, they may ask you to have these tests repeated from time to time to see how your condition is changing.

Types of tests performed

The main imaging tests performed are:

• Fluorescein angiography: This involves injecting a special dye into a vein in your arm. Then, a special camera takes pictures of the dye as it travels through the blood vessels inside your eye. This allows you to see problems with your blood vessels, such as new blood vessels, clearly.
• Optical coherence tomography (OCT): This is like a scan of the inside of the eye. It uses light beams to take cross-sectional pictures of the inside of the eye. It can look at things like the thickness of the layers of the retina, fluid buildup, and new blood vessels.
• Fundus autofluorescence: This test uses a natural substance called lipofuscin found inside the eye to detect changes and damage to the cells in the eye.

The doctor will decide what treatment you need based on the information obtained from these tests.

Is there a treatment for Angioid Streaks?

There is no specific treatment for Angioid Streaks. That is, there is currently no cure for the streaks. However, the most important thing is to treat the complications that arise from them, and to treat any underlying conditions that may be associated with them (like those on the PEPSI list).

Specific treatments for complications

If you have a condition like the one we talked about called ``choroidal neovascularization'' (i.e. the formation of new, unwanted blood vessels), your doctor may suggest treatments like these:

• Photocoagulation: This uses a laser to destroy the unwanted blood vessels.
• Photodynamic therapy (PDT): This involves administering a special light-sensitive drug to your body, then directing a special light beam into your eye to destroy the unwanted blood vessels.
• Anti-vascular endothelial growth factor (anti-VEGF) drugs: These are the most commonly used treatment. They involve injecting a special drug into the jelly-like fluid inside the eye called the vitreous humor. These drugs control the growth of new blood vessels. They are also called VEGF inhibitors. These injections may need to be repeated monthly or as needed.
• Using PDT and anti-VEGF drugs together: Sometimes these two treatments can be used together.

Are there any side effects/complications of the treatment?

As with any medical treatment, these treatments can have some side effects or complications. It's good to be aware of that as well.

• Laser photocoagulation: While this may clear vision in the short term, it can sometimes damage healthy tissue, causing retinal hemorrhages and loss of central vision.
• Anti-VEGF drugs: Side effects from these injections are usually short-term. They can include eye pain, redness, tearing, and floaters. There is a very small risk of serious eye infection with each injection.
• PDT treatment: There may be a temporary increase in sunburn after this. There may also be a blind spot in the vision. There may be allergic reactions to the light-sensitizing drugs, and rarely, new, unwanted blood vessels may form.

If a treatment is suggested to you, it is very important to thoroughly discuss the pros, cons, and possible side effects with your doctor.

What happens if I have Angioid Streaks?

If you only have angioid streaks, that is, if there are no other complications, it is not that dangerous. However, if you have an eye injury, you should definitely see an ophthalmologist and get treatment.

If you have an underlying systemic condition that causes your angioid streaks, it is very important to follow your doctor's treatment plan and get the necessary eye care.

Can this be prevented? How can the risk be reduced?

There is no way to prevent angioid streaks caused by underlying medical conditions. However, you can prevent those caused by eye injuries.

Protecting your eyes is the most important thing here. Wearing protective eye gear can help reduce the risk of:

• When working with machinery or things that could cause eye injury (e.g. welding, using a grinder, woodworking).
• When riding a motorcycle (with the visor on the helmet).
• When engaging in slightly strenuous sports (e.g. playing cricket, especially when hitting the bat, fielding).
• When working in the garden, especially when cutting branches and clearing bushes.

What are the best times to see a doctor?

It's a good idea to see an ophthalmologist regularly to get your eyes checked. If you have an eye condition or another condition that can affect your eyes, you may need to see your doctor more often.

If you experience any of these eye problems, see an ophthalmologist immediately:

• If you have eye pain.
• If you experience any changes in vision (e.g. blurring, distortion, dark spots).

In this case, see a doctor immediately or go to an emergency room:

• If you get an eye injury.
• If you experience severe pain or bleeding inside the eye.
• If your vision suddenly disappears or becomes very dim.

Questions to ask the doctor/doctor

Once you know you have Angioid Streaks, you can ask your doctor questions like these:

• Why do I have these angioid streaks?
• What kind of treatment do I need?
• What are the side effects of these treatments?
• How often should I see you?
• What other specialists should I see (e.g. for an underlying condition)?
• What new symptoms or signs of worsening condition should I look out for?
• What will my condition be like going forward (prognosis)?

What is the difference between `Lacquer cracks` and `Angioid Streaks`?

Both of these are things that look like streaks inside the eye when you examine the eyes. However, their appearance and causes are different.

• Lacquer cracks: These are often seen in the eyes of people who are extremely myopic (nearsighted).
• Angioid Streaks: These can be caused by some of the conditions we discussed earlier, or by damage to the eye.

Sometimes, if the appearance of these lines is not clear, the doctor may need to perform imaging tests like OCT to accurately distinguish between the two.

Finally, the take-home message

If you have angioid streaks, you may not even know it. They are often discovered by a doctor during a routine eye exam. In most cases, there is nothing you can do about them other than observe them. That is, just wait and see if they change.

However, sometimes your doctor may think you have an underlying medical condition that is related to this. If that's the case, you may need to have further tests.

The most important thing is to not be afraid and to listen carefully to what your doctor says. Be sure to ask questions about what tests you will be having and what the results will tell you. Your medical team is there to support you and help you make the right decisions. Get regular eye exams and protect your eyes, and you can reduce the risk of many problems.

` Angioid Streaks, Angioid Streaks, Eye Diseases, Eye Streaks, Retina, Bruch's Membrane, Eye Health