Central Serous Choroidopathy

What is Central Serous Choroidopathy?

Central Serous Choroidopathy (CSC), also known as Central Serous Retinopathy (CSR), is a disease that causes fluid build-up beneath the retina. This leakage of fluid comes from the layers under the retina, the retinal pigment epithelium (RPE) and choroid. This condition generally affects a person’s central vision.

Diagnosis

Central serous can be diagnosed by examining the retina with special lenses allowing a view of the back of the eye. A blistering of the retina may be seen. Some cases are very subtle and additional testing is required. Fluorescein angiography will show a spot of leakage which, in some cases, might have accumulated into a classic “smoke-stack” pattern and may be used to identify complications including choroidal neovascularization. Indocyanine Green (ICG) angiography supports the role of the choroid in this disease and is rarely useful in management. We now use high-resolution optical coherence tomography (OCT) to identify fluid under the retina and to identify subtle cases that might otherwise be missed.

Who is at risk?

While there is no definite known cause for this condition, we do know that it usually affects young males between the ages of 20-45. However, women may also be affected. Risk factors for the development of this condition include a “type A personality”, the use of steroids, caffeine or other stimulants (e.g., energy drinks, dietary supplements), as well as smoking, a history of trauma, physical/emotional stress.

Signs and Symptoms

Signs of central serous can include an elevation of the central retina (macula), deposits beneath the retina, dark and light color changes (hyper- and hypo-pigmentation), and, in complex cases, blood, fat deposits (lipid) and scarring (fibrosis). The “normal eye” often has subtle changes as well. Symptoms include blurred central vision, small image size (micropsia), and distortion of the image (metamorphosia). After central serous resolves, most patients will still have residual symptoms such as distortion, decreased color and contrast sensitivity, and vision difficulty at night. There is also a 40-50% change of recurrence over time. In some cases, the longterm complications may be due to residual chronic activity and a more detailed evaluation of the disease process may improve the visual results.

Treatments

While there is no known cure, treatment is directed at the underlying modifiable risk factors such as removal of stimulants from the diet (e.g., smoking, caffeine, energy drinks, steroids) and improved life style (e.g., more sleep = less stress). Normally this condition clears up in a month or two. In patients with more severe vision loss or a prolonged course of the disease, laser treatment has been shown to reduce the course of the disease and improve vision. In some complex cases, we may consider treatment with a “cold laser” (photodynamic therapy with Visudyne), intraocular injections of anti-VEGF drugs such as Avastin, or a combination of these treatments. Non-steroidal anti-inflammatory drugs (NSAIDS) have been shown, experimentally, to stimulate fluid absorption but have not been proven in a controlled clinical trial. The newest treatment options may improve outcomes and we specialize in the latest testing and treatments here at the Retina Macula Institute.