With age, lipid-containing extracellular deposits may accumulate between the membrane and the basal lamina of the retinal pigmental epithelium, impairing exchange of solutes and contributing to age-related pathology.

Inflammatory and neovascular mediators can then invite choroidal vessels to grow into and beyond the fragmented membrane.

This neovascular membrane destroys the architecture of the outer retina and leads to sudden loss of central vision – wet age related macular degeneration.

Pseudoxanthoma elasticum, myopia and trauma can also cause defects in Bruch's membrane which may lead to choroidal neovascularization.

Alport's Syndrome, a genetic disorder affecting the alpha(IV) collagen chains, can also lead to defects in the Bruch membrane such as 'dot and fleck' retinopathy.