Treatment for Angioid Streaks with Subretinal Neovascularization

(Question submitted in 2004)I am a 44 year old male with angioid streaks in both eyes. My right eye has central vision loss ( 20/200). My left eye has not developed any problems yet. I was disappointed to read the chances of my left eye developing problems. Is there anything at all I can do to decrease chance of leakage? I have had 7 PDT treatments along with 5 Kenalog injections. I am receiving treatment from Dr. G. Is there anything else available out there? Please advise me of any options I have.

Answer:

(Answer updated 6/22/2010). For the era when you were receiving care for your active disease it sounds like you were getting excellent care from Dr. G. A combination of intravitreal kenalog and photodynamic therapy was probably as good a treatment as there was at that time, especially if you hd no pressure problems after the Kenalog injections. I had one patient with angioid streaks and subretinal neovascularization in whom I have used this combination who did develop pressure problems difficult to control with drops. PDT and kenalog injections have been abandoned in your situation since the discovery that vascular endothelial growth factor (VEGF) blocking drugs such as Avastin and Lucentis work better. Other newer anti-VEGF drugs are being developed which may last longer and lead to decreased numbers of ocular injections. Thus, there is valid hope that we will have more weapons if and when your second eye is affected. Your email did not mention if you have pseudoxanthoma elasticum (PXE), a systemic condition which frequently underlies angioid streaks. Please check this out with your ophthalmologist, as the answer has important other implications for you, and any children you have. If you do have PXE, then you need to be aware of possible cardiovascular and gastrointestinal effects of this disease, and the potential to transmit the condition to your children, and thus the need to have their eyes checked. If not, and if you have none of the other less common conditions which can underlie angioid streaks, then you do not have these additional concerns. Best wishes in your fight with this disease.