As Bruch's membrane becomes increasingly brittle, angioid streaks--fractures radiating from the optic disc--form and enlarge with age, predisposing strongly to choroidal neovascularization (CNV). CNV commonly emerges in mid-adulthood, recurs, and can lead to hemorrhage, scarring, and permanent loss of central vision. Independent of CNV, chronic dysfunction of the calcified membrane drives macular atrophy, causing enlarging scotomas and declining acuity.

Pre-clinical functional impairment includes delayed dark