Central Serous Retinopathy

Central serous retinopathy causes central vision loss secondary to fluid leaking under the center of the macula.

What is a Central Serous Retinopathy?

Moderate central vision loss in men (90% of these cases are men) aged 40 to 60 is sometimes caused by central serous retinopathy. Central serous retinopathy is caused by excessively leaky blood vessels in the choroid which is the layer of blood vessels under the retina. When these vessels become excessively leaky, fluid builds up in the choroid and some of that fluid can break through the barrier of the retinal pigment epithelium. The retinal pigment epithelium is a single layer of cells under that retina that are water tight. The fluid that breaks through the retinal pigment epithelium builds up under the retina forming a blister of fluid under the retina. This fluid blurs the vision in two ways. First, because the retina is elevated away from the retinal pigment epithelium by the fluid, it does not receive nutrients and oxygen as efficiently as it should and it doesn't work well. Second, because the retina is not where it should be, images become out of focus. Some people with central serous retinopathy will notice if they wear reading glasses, they can see better because the reading glasses can sometimes refocus the image on the elevated retina.

Cause of Central Serous Retinopathy

The animated image shows a classic smokestack on fluorescein angiography in a patient with acute central serous retinopathy. The white trace dye, fluorescein, does not leak out of the pigment epithelium under the retina. In patients with central serous retinopathy, there is leakage in the choroid of fluid that builds up and then pushes through the barrier layer under the retina, the retina pigment epithelium. That shows up as a leaky spot on the fluorescein angiogram. Because of the concentration gradient in the subretinal fluid, the fluorescein dye moves up from the leaky spot and forms a smokestack looking white are under the center of the macula.

Central Serous Retinopathy and Fundus Autofluorescence

There are several tests that can be done to establish the diagnosis of central serous retinopathy and to help guide management. Fundus autofluorescence - in the accompanying photograph, show the area of bright autofluorescence from the serous retinal detachment. The photoreceptor outer segments that accumulate in the serous retinal detachment autofluoresce and show up bright in the image. Also optical coherence tomography can show the choroidal thickening and the subretinal fluid. Fluorescein angiography and indocyaning green angiography will show which areas of the choroid are leaking and can help guide treatment.

Who develops Central Serous Retinopathy

Central serous retinopathy is associated with Type A personality. Ninety percent of cases occur in men. It is also sometimes seen in people taking steroids orally or by nasal spray. It can also be associated with pregnancy. Serous retinal detachments like those seen in central serous retinopathy can also seen in patients with severe high blood pressure, age related macular degeneration, and posterior uveitis.

The diagnosis of central serous retinopathy is usually established with optical coherence tomography, fluorescein angiography, and sometimes indocyanine green angiography.

Visual acuity usually returns to normal within about 6 months (sometimes sooner) in 95 percent of affected patients. The recurrence rate is 25 percent. If vision does not recover in a reasonably amount of time, hot laser, photodynamic therapy (cold laser) can be considered.

What is Chronic Central Serous Retinopathy

There are some patient who develop chronic central serous retinopathy. Those patients have subretinal fluid for more than 6 months. Sometimes subretinal fluid will persist for years. In those situations, the chronic subretinal fluid causes damage to the pigment epithelium and the overlying retina. Vision loss gradually develops. When a patient is treated for chronic subretinal fluid, even when the fluid goes away, there is often residual vision loss. Sometimes, with treatment, the vision loss can be stabilized or slowed. The accompanying image shows gutters where the chronic subretinal fluid tracks down due to gravity and causes damage that is visible with testing.

Central Serous Retinopathy Treatment

Very few patients with central serous retinopathy require treatment. 90% of patients improve without therapy. Sometimes, central serous retinopathy becomes chronic and causes vision loss that does not improve. Focal laser treatment to the leaking spot is usually effective in patients with CSR. More commonly, photodynamic laser with visudyne is used to treat CSR. Photodynamic laser is a very low power laser which is used to activate the visudyne. The visudyne is infused intravenously over 10 minutes then a 5 minute washout period is observed. Then 86 seconds of laser (low enegery) is used to activate the the drug and seal up the leaky areas in the choroid. This treatment is usually effective. It is likely safer than focal laser but does sometimes need to be repeated.

Central Serous Retinopathy NEWS

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MD Magazine

Safety, Tolerability Increases Post-Bevacizumab Injection in Intraocular Pressure
MD Magazine
Ten eyes had age-related macular degeneration (AMD), 7 had proliferative diabetic retinopathy, 6 had central retinal vein occlusion, 5 had central serous chorioretinopathy, and 3 had with diabetic macular edema (DME). All 42 eyes were receiving an ...


ModernMedicine

Research offers insights on clinical course, management of CSCR
ModernMedicine
Acute central serous chorioretinopathy (CSCR) resolves within six months in the majority of patients, but findings from new research suggests ways to identify individuals at risk for longer duration and a new approach to treating patients with severe ...


Friday's Hawaiian Eye 2018 speakers of the day named
Healio
WAILEA, Hawaii — John P. Berdahl, MD, received the Hawaiian Eye Comprehensive Program's Speaker of the Day for Friday, Jan. 19. Berdahl moderated a panel discussion titled “Redeeming the unhappy patient.” Sophie J. Bakri, MD, was awarded Speaker of ...


Medscape

Central Serous Retinopathy Requires Individualized Approach
Medscape
Central Serous Retinopathy Requires Individualized Approach. Caroline Helwick. June 25, 2017. WASHINGTON, DC — One treatment clearly does not fit all patients with central serous retinopathy (CSR). Determining which approach to try on which patient ...


Patients respond differently to central serous retinopathy treatment
Healio
Differential diagnoses include exudative maculopathy, choroidal tumors, choroidal neovascular membrane, inflammatory disease and serous retinal detachment (SRD), she said. Attar and Rafieetary reported on five cases of central serous retinopathy (CSR ...


Long-term outcomes in half-dose verteporfin photodynamic therapy for chronic central serous retinopathy
Dove Medical Press
Objective: To evaluate the short- and long-term outcomes of half-dose verteporfin with photodynamic therapy (PDT) in the treatment of chronic central serous retinopathy (CSR). Design: Retrospective case series. Participants: 45 eyes in 39 patients with ...


Questions remain about use of 'nondamaging' retinal laser therapies
Healio
Prince Hamlet in the so-called “nunnery scene” of William Shakespeare's play Hamlet did not deal with laser irradiation but still can inspire our modern dilemma in ophthalmology: Is “nondamaging” retinal laser therapy, as Wood and colleagues named it ...


ModernMedicine

Central serous retinopathy helped by NSAIDs
ModernMedicine
A 27-year-old male whose last eye examination was seven years earlier in India presented to University of Alabama at Birmingham Eye Care for a comprehensive eye examination. He wore no refractive correction but complained of blurry vision at distance ...


Dove Medical Press

Subthreshold microsecond laser for proliferative diabetic retinopathy: a randomized pilot study
Dove Medical Press
Aim: To compare the outcomes of subthreshold microsecond (STM) and continuous-wave laser (CWL) panretinal photocoagulation (PRP). Methods: In this randomized, prospective, pilot study, 20 eyes of 10 subjects with symmetric severe non-proliferative ...


Photostimulation promising for central serous chorioretinopathy
ModernMedicine
Bucaramanga, Colombia—Central serous chorioretinopathy (CSC) is a fairly common retinal disorder that has been associated with “type A” personalities. The primary complaints upon presentation are usually limited to distorted vision, decreased color ...


Medscape

Central Serous Chorioretinopathy: Risk Factors Identified
Medscape
Hypertension, Helicobacter pylori infection, steroid use, sleep disturbances, autoimmune disease, psychopharmacologic medication use, and type A behavior are possible risk factors for central serous chorioretinopathy (CSC), according to a systematic ...


Choriocapillaris Changes Imaged by OCT Angiography After Half-Dose Photodynamic Therapy for Chronic Central ...
Healio
From Kansai Medical University, Hirakata City, Osaka, Japan (KF); and Nihon University, Chiyoda, Tokyo (AK, MY). Dr. Yuzawa reports grants, personal fees, and non-financial support from Novartis and Santen; grants and personal fees from Alcon Japan ...


Half-dose verteporfin PDT increases visual acuity, reduces recurrence in central serous chorioretinopathy
Healio
COLORADO SPRINGS, Colo. — Photodynamic therapy with half-dose verteporfin significantly increased visual acuity in eyes with central serous chorioretinopathy compared with that in untreated controls, according to a study presented here. Furthermore ...


Irish Examiner

The flotsam and jetsam of the artistic life
Irish Examiner
I developed a condition called CSR [central serous retinopathy] and I lost the central vision in my right eye and some in my left eye. “Since then, the condition has stabilised, but it takes a while for your eyesight to adjust.” Bénédicte Coleman's ...


ModernMedicine

New insights on 'pachychoroid spectrum'
ModernMedicine
Central serous chorioretinopathy (CSC) is the diagnosis that usually comes to mind when retinal specialists see an eye with choroidal thickening. New insights on choroidal pathology obtained using advanced imaging techniques, however, have led to the ...

and more »

Manila Bulletin

High-tech 3D optical test free at BMC Eye Center
Manila Bulletin
Malolos City, Bulacan — The Bulacan Medical Center (BMC) Eye Center now offers optical coherence tomography (OCT) services, a non-invasive imaging test often referred to as the “3D Eye Scan” for free. Dr. Joseph E. Ramos, BMC ophthalmologist, said the ...

and more »

How to manage solar retinopathy caused by viewing the eclipse
Healio
Jerome Sherman, OD, FAAO, provides tips on how to handle inquiries from patients who may be suffering from solar retinopathy. Sherman is a member of the Primary Care Optometry News Editorial Board, Distinguished Teaching Professor at the SUNY College ...


Treating Central Serous Retinopathy: Adjunctive Nutritional Management
Dynamic Chiropractic
Clin Exper Ophthalmol, 2005;33(4):437-9. Fernández Hortelano A, Sádaba LM, Heras Mulero H, García Layana A. [Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids] (in Spanish; Castilian). Arch Soc ...


PDT should be considered for chronic central serous chorioretinopathy
Healio
WAILEA, Hawaii — Retina specialists should consider photodynamic therapy as an adjunctive treatment for chronic central serous chorioretinopathy, according to a study presented here. “PDT has been impressively good,” Rishi P. Singh, MD, said at Retina ...


Photonics.com

FDA Approves Quantel Devices
Photonics.com
The Easyret has a broad range of settings for treatment of pathologies such as diabetic retinopathy, macular edema and central serous chorioretinopathy. In addition to SingleSpot treatment mode, surgeons can select Multispot mode for a pattern of ...


Optometry's Meeting by the American Optometric Association (AOA)
Medscape
Conference News. AOA Corneal Edema: Is Your Patient Receiving Amantadine? Medscape Medical News, June 28, 2017. Novel Multifocal Contact Lens Technologies Get High Ratings. Medscape Medical News, June 27, 2017. HCPs Can Learn 'Best Practices' From ...


Motherboard

More Ways To Wreck Your Eyes Without Even Thinking About It
Motherboard
The first is retinopathy similar to the diabetic variation above. Like overfilling a balloon, too much pressure causes the tiny blood vessels of the eye to bubble and swell, potentially leading to tearing and breaking. The ensuing bleeding can block ...


Today.com

Solar eclipse: Using adaptive optics to understand eye damage
Science Daily
"We have never seen the cellular damage from an eclipse because this event rarely happens and we haven't had this type of advanced technology to examine solar retinopathy until recently," said lead investigator Avnish Deobhakta, MD, Assistant Professor ...
A record number of Americans viewed the 2017 solar eclipse | University of Michigan NewsUniversity of Michigan News
Acute Solar Retinopathy Imaged With Adaptive Optics and Optical Coherence Tomography | Ophthalmic Imaging ...The JAMA Network
New imaging finds crescent-shaped eye damage in woman who viewed eclipseCNN
Mount Sinai
all 118 news articles »

Likely new treatment target identified for diabetic retinopathy
Science Daily
Now scientists have identified a new target for reducing that dysfunctional blood vessel development in the eye in a common condition called diabetic retinopathy, the leading cause of blindness in working-age adults. "If we block the adenosine receptor ...


Using OCTA in optometric practice
ModernMedicine
OCTA has been very useful in age-related macular degeneration (AMD) as well as diabetic retinopathy and related ischemia. Other advantages are the ability to look for capillary non-perfusion in vein occlusions and optic nerve head perfusion in glaucoma ...


Science Daily

Diabetic blindness: Protein that plays key role
Science Daily
Researchers at University of Utah Health have identified a protein (ARF6) that when inhibited reduces diabetic retinopathy, a condition that results when blood vessels at the back of the eye leak fluid into the eye, impairing vision. Published in the ...


NSAIDs Speed Central Serous Choroidopathy Recovery
Medscape
NSAIDs Speed Central Serous Choroidopathy Recovery. Caroline Helwick. November 27, 2013. NEW ORLEANS — Patients with central serous choroidopathy treated with nonsteroidal anti-inflammatory drug (NSAID) eyedrops recover faster than when they are not ...

and more »

Healio

Young woman reports blurry vision in one eye, spots, floaters
Healio
The macular OCT scans clearly showed the areas of serous detachment and revealed choroidal folding. In addition to this, there were pinpoint hyper-reflective spots in the region of serous detachment between the retinal pigment epithelium (RPE) and ...


Washington Post

ESPN's Britt McHenry says she feared for her life, had health issues after viral rant
Washington Post
At first, McHenry ignored reading posts about the incident and poured all of her energy into her work. “I believed I had to prove my professional credibility all over again, starting from zero — actually, from less than zero,” she said. A few months ...
ESPN reporter who was filmed belittling a tow truck employee last year now says the stress of it all has damaged her ...Daily Mail
ESPN's Britt McHenry: "I Blame Myself, but the Video Is Not Who I Am"MarieClaire.com

all 30 news articles »

Reader's Digest

One Doctor Said I'd Go Blind Within 2 Weeks. But a Second Opinion Changed Everything.
Reader's Digest
After about ten minutes, he said, “Well, from what I hear, I think you have central serous retinopathy. It's induced by stress, and although it's rare—it occurs in only one in 100,000 females—it's more common in young people.” He found a handout ...

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