Editor’s Note: Welcome to “Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Alejandro Lavaque, MD. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or MultiMedia Healthcare, LLC.
In patients with central serous chorioretinopathy (CSR), fluid accumulates under the retina, causing a serous detachment and vision loss. The condition occurs most often in young and middle-aged adults (20 to 50 years of age), with men being affected more often than women. Although vision loss with CSR is usually temporary, it can recur and become chronic anywhere from 30% to 50% of the time.1
Presentation and background
The most common symptom that patients present with is blurry central vision in one eye. Patients may also complain of micropsia, metamorphosia, hyperopic shift, central scotoma, and reduced contrast sensitivity.1 Upon examination, the patient will often have some involvement in the other eye. Depending on the location and amount of subretinal fluid, patients may not have any symptoms.
The exact causes of CSR are not fully understood. However, it is known that systemic exposure to corticosteroids is a risk factor.2 An association has also been made between CSC and patients with so-called type A personalities.3 It has been hypothesized that the body’s natural corticosteroids produced when under stress may trigger CSR in prone individuals. This makes the condition a “reactive choroiditis.”
Alejandro Lavaque, MD, CEO
E: [email protected].
Dr. Lavaque is chief executive officer of Centro de Especialidades Oftalmológicas, Tucumán, Argentina. He is a consultant to Topcon.
1. Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002. Ophthalmology. 2008;115:169-173. doi:10.1016/j.ophtha.2007.02.032.
2. Garg S, Dada T, Talwar D, Biswas N. Endogenous cortisol profile in patients with central serous chorioretinopathy. Br J Ophthalmol. 1997;81:962-964.
3. Yannuzzi LA. Type A behavior and central serous chorioretinopathy. Trans Am Ophthalmol Soc. 1986;84:799-845.
4. Weenink AC, Borsje RA, Oosterhuis JA. Familial chronic central serous chorioretinopathy. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z Für Augenheilkd. 2001;215:183-187. doi:50855.
5. ASRS. Retina Health Series. https://www.asrs.org/patients/retinal-diseases/21/central-serous-chorior... .
6. Lai TYY, Chan W-M, Li H, Lai RYK, Liu DTL, Lam DSC. Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short-term pilot study. Br J Ophthalmol. 2006;90:869-874. doi:10.1136/bjo.2006.090282.
7. Kim S-W, Oh J, Oh IK, Huh K. Retinal pigment epithelial tear after half fluence pdt for serous pigment epithelial detachment in central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging. 2009;40:300-303. doi:10.3928/15428877-20090430-14.
8. Lee PY, Kim KS, Lee WK. Severe choroidal ischemia following Photodynamic Therapy for pigment epithelial detachment and chronic central serous chorioretinopathy. Jpn J Ophthalmol. 2009;53:52-56. doi:10.1007/s10384-008-0613-z.
9. Reibaldi M, Cardascia N, Longo A, et al. Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 2010;149:307-315.e2. doi:10.1016/j.ajo.2009.08.026.