Angioid streaks usually look like linear dark red or gray lines beneath the retina and retinal blood vessels.  The streaks ring the optic nerve about 25% of the time and radiate out from the optic nerve about 75% of the time.

The lesions are called "angioid" because they look like retinal blood vessels.  In the photos to the right, the yellow arrows point to the angioid streaks.  The blood vessels are the red and purple linear vessels originating in the optic nerve (white circle to the right). 

 

Angioid streaks are cracks in a stiff layer deep to the retina called Bruch's membrane.  Because this layer is associated with retinal pigment epithelium (which is pigmented), cracks in this layer allow visualization of underlying vascular areas which look reddish.

 

 

Half of patients with angioid streaks have no systemic disease associated with angioid streaks.

 

The most common associated diseases are:

 

Psuedoxanthoma elasticum

Paget Disease

Ehlers-Danlos Syndrome

Sickle Cell Anemia (and trait and other hemoglobinopathies).

Patients with angioid streaks can lose central vision if a streak happens to run through the central vision.  A much more common cause of central vision loss is when a blood vessel growth, like what is seen in wet macular degeneration, grows from an angioid streak causing scarring and bleeding.  The patient pictured to the right has a blood vessel growth that is not in the central vision.  He is being treated with Avastin.