**Question:** Angioid streak is seen in-

A. Age-related macular degeneration
B. Glaucoma
C. Polymicrobial endophthalmitis
D. Nutritional deficiency

**Core Concept:**
Angioid streaks are irregular, branched, and linear lesions that involve the choroid and sometimes the sclera. They are characterized by the disorganization of the choroidal vasculature, which can lead to choroidal neovascularization and subsequent vision loss. Angioid streaks are primarily associated with systemic conditions that affect the connective tissue, specifically those involving the extracellular matrix (ECM) and collagen synthesis.

**Why the Correct Answer is Right:**
Angioid streaks are primarily seen in patients with Age-related Macular Degeneration (AMD). In this condition, there is a disruption in the balance between the catabolic and anabolic processes of the extracellular matrix (ECM) in the choroid. This imbalance leads to the breakdown of the ECM, causing the irregular, branched, and linear lesions that are characteristic of angioid streaks.

**Why Each Wrong Option is Incorrect:**

A. Glaucoma (Option B) is a group of eye conditions characterized by increased intraocular pressure (IOP) leading to optic nerve damage. Angioid streaks are not a feature of glaucoma and occur due to the disruption of ECM in AMD.

B. Nutritional deficiency (Option D) does not cause angioid streaks. The condition is linked to systemic connective tissue disorders affecting the synthesis and degradation of collagen and ECM.

C. Polymicrobial endophthalmitis (Option C) is an infectious inflammation of the eyeball involving multiple microorganisms. Angioid streaks are not a feature of endophthalmitis and are primarily associated with systemic conditions affecting the ECM and collagen synthesis.

**Clinical Pearl:**
Angioid streaks are often referred to as "Cogan's striae," named after the ophthalmologist Reese C. Cogan who first described them in 1948. They are an important clinical feature in the diagnosis and management of AMD, as they can lead to choroidal neovascularization and subsequent complications such as subretinal hemorrhage, fibrosis, and choroidal detachment. Early recognition and management of AMD are crucial to prevent visual impairment and blindness.