While central serous retinopathy (CSR) might not rank alongside prevalent diseases like cancer and heart disease, it is one of the most common sight-threatening retinopathies (diseases of the retina) worldwide1. As such, CSR should be taken very seriously. 

CSR remains a highly enigmatic condition, largely due to a natural history of spontaneous improvement in a large number of patients2. However, it can be dangerous to sit back and wait for your condition to improve – after all, prolonged central serous retinopathy could lead to vision loss that greatly impacts one’s quality of life. 

When should you seek treatment for CSR? What are some symptoms to look out for? And what are the complications that could occur?

Before we dive into a bird’s eye view of the condition, here’s a TL;DR on central serous retinopathy:

  • A person with early-stage CSR will likely experience blurry vision.
  • In certain cases, an individual may not notice any changes in their vision.
  • CSR can cause both temporary and permanent vision loss.
  • Central serous retinopathy can go away on its own.

What is central serous retinopathy?

Central serous retinopathy (CSR) is a condition that affects the central part of the retina in the eye. This central area is otherwise known as the macula, and is highly receptive to light. CSR occurs when the retina’s layers separate because of the collection of fluid between them, as would a blister.

Retinas

Source: Ophthalmology Retina

The retina is responsible for translating light that enters the eye into images that can be understood by the brain. The build-up of liquid in the layers of the retina can cause the retina to detach, and this can lead to a loss of vision.

In some CSR cases, a patient will recover their vision after a short period, and may not require any treatment. However, our eyesight is not something to be trifled with – you should see your doctor immediately if you start to notice changes in your vision.

What are the symptoms of central serous retinopathy?

In certain cases, central serous retinopathy might not actually produce symptoms. This happens when fluid builds up in areas that are not around the macula. If so, an individual may unknowingly experience a gradual degradation of their eye health and vision.

However, in most other cases, CSR presents with symptoms. Here are a few common indicators to look out for:

  • Blurry vision
  • Objects appear farther away than they are
  • Whites appear duller
  • Lines appear crooked
  • A dark spot in the centre of vision (or dark, blurry vision)

Normal Grid VS Central Serous Affected View

Often, symptoms might be present in only one eye. However, symptoms might develop in each eye at separate points in life.

What are the risk factors and causes of central serous retinopathy?

While the exact causes of central serous retinopathy are not known, the condition has been largely associated with stress, steroid use, and hormonal or endocrine conditions. The following factors may contribute to the development of CSR:

  • Stress: Stress causes the body to produce a hormone called cortisol, which causes inflammation in the body. While there is a link between stress and CSR, this is often difficult to quantify or verify.
  • Steroid use: Individuals taking corticosteroids are at a greater risk of developing central serous retinopathy.
  • Age and gender: The majority of CSR cases are reported in middle-aged men (between the ages of 30 to 50). Males are 5-10 times more likely to be affected than women, who are less likely to develop the condition.
  • Use of TCM: Some herbal medicines3, especially those containing ginseng, may worsen the condition.

What are the treatment options available in Singapore for central serous retinopathy?

To make a diagnosis, your eye doctor will conduct a full medical history check and eye examination, in order to uncover or rule out any underlying comorbidities.

Even if treatment is not required, your care team should still continue to closely monitor your condition to ensure that the fluid in their eye is draining. It is important to note that while most CSR fluid tends to drain away over the course of a few weeks, certain conditions may require timely intervention.

As such, it is crucial that you do not take a sit-and-wait approach if you notice any symptoms. Some treatment options available in Singapore include:

Thermal laser treatment

Thermal laser treatment is a highly effective procedure, but presents slightly more risk than photodynamic therapy as it actually seals leaks in the eye. Thus, there is a higher likelihood of developing scar tissue.

Photodynamic therapy

Wherein a doctor injects a drug called verteporfin into a patient’s arm, which then travels to the eye. Upon reaching the eye, the doctor focuses a cool laser on the part of the eye responsible for leaking fluid; the laser then awakens the verteporfin, which is effective in stopping the leak and preventing future leaks from happening.

Medications

As an example, anti-vascular endothelial growth factor medication is used to prevent the growth of more blood vessels in the eyes. This helps limit and manage future eye vision problems.

Lifestyle changes

These include forming new habits such as exercising regularly, reducing stress levels, sleeping for at least 7 hours nightly, and avoiding or reducing one’s alcohol and caffeine intake.

Stopping or replacing steroid medication

People who are having treatment for central serous retinopathy should avoid any drugs containing steroids. Patients should consult with their doctor before stopping the steroids.

What are the complications of central serous retinopathy?

Due in large part to the propensity for CSR to resolve spontaneously, and its waxing and waning nature, the popular initial approach prior to treatment is observation. However, this might not be the best approach when it comes to safety, eye health, and treatment efficacy. 

If the fluid underneath the macula does not resolve, central serous retinopathy can lead to permanent central vision loss. Additionally, if a CSR condition lasts more than a year, it can lead to further complications like bullous retinal detachment or RPE detachment.

As you can see, while most CSR patients recover within 4-6 months without requiring any treatment, it remains crucial to keep a watchful eye and nip any progressing conditions in the bud.

Should I seek treatment for central serous retinopathy?

While medical intervention is not always required to regain one’s vision, if you experience gradual or acute vision loss (or changes), please consult a doctor immediately. 

After all, a change in vision can be indicative of other underlying problems. This is especially true for patients with chronic conditions, who need to be doubly aware of recurring CSR.

Early diagnosis and treatment are key for a full recovery, especially since eye conditions can degenerate quickly and suddenly.

Got questions? Feel free to drop us a message and the Asia Retina team would be happy to help.

 

References

  1. Karska-Basta, I., Pociej-Marciak, W., Chrząszcz, M., Żuber-Łaskawiec, K., Sanak, M., & Romanowska-Dixon, B. (2020). Quality of life of patients with central serous chorioretinopathy – a major cause of vision threat among middle-aged individuals. Archives of medical science : AMS, 17(3), 724–730. https://doi.org/10.5114/aoms.2020.92694
  2. Salehi, M., Wenick, A. S., Law, H. A., Evans, J. R., & Gehlbach, P. (2015). Interventions for central serous chorioretinopathy: a network meta-analysis. The Cochrane database of systematic reviews, 2015(12), CD011841. https://doi.org/10.1002/14651858.CD011841.pub2
  3. https://www.singhealth.com.sg/patient-care/conditions-treatments/central-serous-chorioretinopathy 

 

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