Central Serous Retinopathy (CSR), also referred to as Central Serous Chorioretinopathy (CSCR), is a retinal disorder characterized by the accumulation of fluid beneath the central part of the retina. This condition can lead to vision disturbances and should be taken seriously due to its potential for significant vision loss. In this article, we will explore what CSR is, its symptoms, methods for diagnosis, and available treatment options.
Central Serous Retinopathy (CSR) or Central Serous Chorioretinopathy (CSCR): What You Need to Know?
Central Serous Retinopathy is a medical condition characterized by the accumulation of serous fluid beneath the retina. Originally named “central serous retinopathy,” it was later discovered that this fluid originates from the choroid tissue, leading to the adoption of the term “central serous chorioretinopathy.” This condition falls under the category of Pachychoroid Spectrum Diseases.
The term “central” signifies that the fluid typically accumulates at the central visual point, which is the macular region. It’s important to note that the macula, often referred to as the yellow dot, is not a disorder but rather a critical part of the visual system. In CSR, the buildup of fluid often affects the macular area.
Central Serous Retinopathy is sometimes confused with age-related macular degeneration (AMD), but they are distinct conditions. While they differ significantly, chronic cases of CSR can exhibit symptoms similar to AMD. Thus, careful evaluation and diagnosis by a medical professional are crucial for appropriate management.
Central Serous Retinopathy (CSR)
Central Serous Retinopathy presents in various stages. When it initially occurs, it is referred to as “acute CSR.” If the condition persists for 4-6 months without improvement, it becomes “persistent CSR.” In cases where it temporarily improves and then reappears, it is termed “recurrent CSR.” In more severe, long-lasting instances with frequent relapses that result in irreversible damage to vision and retinal pigment epithelium cells, it is categorized as “chronic CSR.
Causes of Central Serous Retinopathy
The precise mechanisms underlying central serous chorioretinopathy (CSR) remain not fully understood. However, it is believed to initiate with the leakage of fluid from the highly vascularized choroid tissue, which is among the body’s most densely vascularized tissues. This leakage subsequently leads to deterioration in the retinal pigment epithelium. In the later stages, the fluid that has leaked from the damaged areas in the retinal pigment epithelium may accumulate under the retina, resulting in the acute presentation of central serous retinopathy.
Notably, CSR is more prevalent among individuals with thicker and more vascular choroidal tissue, supporting this proposed mechanism. It is believed that one triggering factor for this condition is the body’s cortisone levels. Specifically, individuals with a type A (perfectionist) personality may experience elevated cortisone levels due to increased stress, making them more susceptible to the disease. Furthermore, the use of cortisone-containing medications can also trigger CSR in some cases.
Symptoms of Central Serous Retinopathy:
- CSR may manifest with the following symptoms:
- Decreased vision
- Darkened areas in the field of vision
- Faded or paler colors
- Distorted or broken lines
- Objects appearing smaller and distorted.
Who Is Affected by Central Serous Retinopathy?
CSR is most commonly observed in young to middle-aged men, with men being affected three to four times more frequently than women. However, this condition can affect individuals over the age of 20, with rare cases reported in those under 20. After the age of 50, the frequency of CSR in women approaches that of men. Notably, CSR tends to occur more frequently in individuals with a type A (perfectionist) personality, characterized by high stress levels.
Risk Factors for Central Serous Retinopathy?
Stressful personality traits, steroid drug use (cortisone, cortisol), and male gender are the main risk factors for CSR disease. The largest case-control study on CSR ever published in the medical literature was carried out by ophthalmologist Assoc. Prof. M. Giray Ersöz. In this study, it was found that 73% of patients with central serous retinopathy were men. Pregnancy, hyperopia, and smoking were discovered to be additional risk factors for CSR disease (further details about this study are provided under the Scientific Studies heading below).
Additionally, a number of studies have identified risk factors for the emergence of central serous chorioretinopathy (CSCR), including excessive caffeine consumption, sleep apnea, insomnia, and working night shifts.
Can Central Serous Retinopathy Lead to Permanent Vision Loss?
Prof. A. Ersöz and colleagues has demonstrated that if the fluid beneath the retina persists for over three months, it can result in a permanent reduction in visual function. Furthermore, if CSR recurs frequently or becomes chronic, it poses a significant risk of causing irreversible and severe vision loss. This underscores the importance of timely diagnosis and appropriate management to prevent long-term visual impairment.
Is Central Serous Retinopathy Dangerous?
Acute CSR disease does not endanger visual functions if it spontaneously recovers within three months. However, central serous chorioretinopathy (CSCR) disease turns into a condition that is risky for vision if it becomes persistent, recurrent, or chronic.
How is Central Serous Retinopathy Diagnosed?
Following an examination with eye drops, CSR disease is identified using OCT (Optical coherence tomography or eye tomography). Both fluorescein angiography (FFA) and indocyanine green angiography (ICGA, ICG) are required to identify the leaky vessels in the choroid and the leak point in the retina, respectively.
Treatment Options for Central Serous Retinopathy?
Despite the fact that central serous chorioretinopathy is a disease that can heal on its own, 50% of patients never fully recover from the condition, and 50% of those who do relapse after the initial attack. Treatment should not be postponed in cases that are persistent or recurrent because the disease may result in serious vision loss if it becomes chronic. Central serous retinopathy has been treated using a wide range of techniques. Subthreshold laser treatments are the second most effective of these, with photodynamic therapy coming in first. Unfortunately, scientific studies have not supported the efficacy of the pill and drop therapies used by many doctors. Only a very small percentage of patients respond well to intraocular needle treatments.
Central Serous Retinopathy treatment
Photodynamic Therapy (PDT)
Photodynamic therapy, also known as cold laser therapy, is a treatment approach used for central serous retinopathy, or central serous chorioretinopathy. In PDT, a drug called Visudyne is administered intravenously, followed by the application of a cold laser to target the areas where fluid leakage occurs in the choroid layer of the eye.
PDT has been recognized as one of the most effective treatments for CSR. However, worldwide availability of the drug Visudyne, a crucial component of this therapy, has faced challenges. Periodic shortages of the drug have led to reduced access to PDT treatments.
Following PDT, patients are advised to avoid sunlight exposure, often requiring them to stay indoors in dimly lit conditions during the initial days. While there may be a temporary decrease in vision during the early stages, the treatment’s full effect typically becomes apparent after about one month, leading to an improvement in vision.
Subthreshold Laser Treatment for CSR:
The second effective method for treating Central Serous Retinopathy is subthreshold laser therapy. Various types of subthreshold lasers, including micropulse, subliminal, and Pascal EPM, are utilized. These lasers are designed not to damage eye tissue. If fluid accumulation persists beyond three months after the initial treatment, reapplication can be considered.
Herbal Treatment for Central Serous Retinopathy:
Regrettably, there is no herbal remedy or treatment for central serous retinopathy. In fact, patients are strongly advised to steer clear of herbal medicines with undisclosed or uncertain ingredients. Given that stress can trigger the condition, individuals diagnosed with central serous retinopathy are often recommended to take vacations and actively reduce stress as part of their overall well-being strategy.
My Scientific Researches on Pachychoroid Spectrum and Central Serous Retinopathy
On the CSR and Pachychoroid Spectrum, I conducted a total of 10 different scientific studies, nine of which were published in international journals. The main four of these studies are summarized below.
- Patient Characteristics and Risk Factors for Central Serous Chorioretinopathy: an analysis of 811 patients (doi: 10.1136/bjophthalmol-2018-312431).
Our study, which stands as the largest case-control investigation in the field, has been published in the prestigious British Journal of Ophthalmology, a leading authority on eye diseases. The research encompassed 1.152 eyes from a cohort of 811 central serous retinopathy (CSR) patients. This comprehensive study unveiled key insights into the demographic profile and risk factors associated with CSR.
The findings indicate a notable gender disparity, with male patients being three times more prevalent than female patients. Among the CSR patients, 58% experienced the condition in one eye, while 42% had it in both eyes. Our research identified several statistically significant independent risk factors contributing to central serous retinopathy. These factors encompass male gender, steroid (cortisone and cortisol) usage, depression-anxiety (reflecting stressful personality traits), smoking, hypermetropia (farsightedness), and pregnancy in women. Notably, the risk of developing CSR was found to increase by 24% for each 1 diopter of hyperopia, highlighting the significance of these findings in the field of ophthalmology.
- Morphological and Functional Changes Immediately After Half-Time Photodynamic Therapy in Patients With Central Serous Chorioretinopathy (doi: 10.3928/23258160-20181203-05).
In this study featured in the esteemed United States-based journal, Ophthalmic Surg Lasers Imaging Retina, notable observations were made following photodynamic therapy for central serous retinopathy (CSR). The study revealed an initial decrease in retinal function and an increase in fluid levels during the first week post-treatment. However, these effects gradually improved in the subsequent days. Significantly, this improvement persisted at a statistically significant level up to the third month, underscoring the positive impact of photodynamic therapy on retinal function and fluid dynamics.
- Outer nuclear layer thickness at the central fovea relation with symptom duration in central serous chorioretinopathy (doi: 10.1007/s10792-018-0950-y).
This research, which was published in the international journal International Ophthalmology, involved 67 CSR patients and 20 healthy subjects. It has been discovered that the layer containing the extensions of the vision-sensing cells thins permanently in patients with central serous retinopathy when the fluid beneath the retina does not pass within 3 months.
- Pachychoroid Pigment Epitheliopathy in Fellow Eyes of Patients with Unilateral Central Serous Chorioretinopathy (doi: 10.1136/bjophthalmol-2017-310724).
Our study, published in the esteemed British Journal of Ophthalmology delved into the experiences of 536 patients with central serous retinopathy (CSR). Among these patients, 52% presented with unilateral CSR.
Notably, our research also shed light on a newly defined condition within the pachychoroid spectrum, known as pachychoroid pigment epitheliopathy. This condition was identified in a significant 61% of patients with unilateral central serous retinopathy. These findings provide valuable insights into the complex landscape of CSR and related conditions.