Central Serous Choroidopathy, also known as Central Serous Retinopathy (CSR) and Central Serous Chorioretinopathy (CSC), is an eye condition which causes visual impairment. It usually occurs in one eye, and it is usually temporary. But studies show that both eyes are affected on a cellular level even when damage is only apparent in one eye.
CSC is characterized by fluid leakage beneath the retina. Fluid leaks from the layer of the eye called the choroid. This is a heavily vascularized membrane that nourishes the retina. The fluid tends to accumulate under the macula or central part of the retina. The fluid blurs and distorts vision.
If enough fluid accumulates, it can lead to retinal detachment. This creates a gray spot in the central visual field.
In order to diagnose CSC, the eye must be dilated for a view of the retina. If CSC appears to be the cause of the visual impairment, an ophthalmologist typically confirms it with optical coherence tomography or fluorescein angiography. Optical coherence tomography involves the use of light to see how well different parts of the eye are working. Fluorescein angiography involves the injection of dye into the vascular network of the eye to observe how blood and fluid are moving. A fluorescent spot will appear where there is fluid leakage.
An Amsler grid may also be used to determine the placement and effect of the damage to the visual field.
CSC is generally considered idiopathic, meaning it arises without a specific cause. However, studies have shown a link between CSC and hypertension, obstructive sleep apnea, corticosteroid use and H. pylori. Groups with those conditions show elevated rates of CSC. Excepting H. pylori, the common culprit in the other conditions appears to be elevated levels of cortisol and epinephrine. Both of these disrupt cellular processes in the delicate structures of the eye.
The disease occurs most frequently in white males between the ages of 20 and 50. The incidence is about 1.7 per 100,000 for women and 9.9 per 100,000 for men.
CSC has also been associated with elevated cortisol. People with CSC have higher levels of cortisol. Cortisol is a hormone secreted by the adrenal glands which helps the body to deal with stress. But in conditions of chronic stress, cortisol levels remain elevated, which damages various tissues of the body.
The prognosis for CSR tends to be very good with visual impairment being mostly temporary. Acute vision loss may cause visual acuity to fall to as low as 20/200. However, over 90% of patients regain 20/30 vision or better within 6 months of diagnosis and treatment.
Once fluid accumulation has resolved and vision has regained good acuity, other problems can remain as a lasting consequence. These include decreased night vision, a reduced ability to see colors, and some visual distortion if scarring occurs. Other complications may include neovascularization and distorted cell growth in the RPE, or retinal pigment epithelium.
Unless the underlying cause, which is frequently elevated cortisol, corticosteroid use or H. pylori infection, is dealt with permanently, the disease can recur and cause progressively increasing vision loss.
In five percent of cases, CSC takes the form of a chronic, diffuse retinopathy. Called Type II Central Serous Retinopathy, there is diffuse, persistent fluid leakage. Unfortunately, this type is harder to treat because leakage is not confined to a specific area. This type requires ongoing clinical consultation.
The most serious complication of CSC is retinal detachment, which is a medical emergency. See – put in link for retinal detachment. Otherwise, in most cases, fluid accumulation spontaneously resolves within 3-4 months. What is most important is to eliminate causes of stress and use of any medications containing corticosteroids. Counseling may be prescribed if elevated cortisol is due to life stressors and an individual’s habitual response to them.
Typically, no treatment is given unless the fluid is still present after a few months. If the fluid is still present after 3-4 months, various treatments may be tried.
Laser photocoagulation has been used to burn leakage areas shut. But this can further damage vision and is not effective unless leakage areas are confined and are not located too close to the center of the retina. However, it has shown improved outcomes under the prior conditions, especially in patients with recurring episodes of CSC.
Photodynamic therapy (PDT) with verteporfin has seemed like an effective treatment with minimal complications. It works even in the chronic variant of the disease and has become a first-line treatment in the literature.
Possible oral treatments include low-dose methotrexate, mifepristone (a cortisol blocker), oral rifampin and, in cases where neovascularization has occurred, anti-VEGFs may be given.
Sometimes eye doctors recommend other modalities of stress reduction, such as yoga and meditation. The disease shows a strong association with Type A personality types, who do not excel at relaxation. Cortisol damages other tissues of the body in addition to the eyes. In particular, it shrinks the hippocampus, a region of the brain associated with both happiness and memory.
Another great cortisol reduction technique is to undertake some form of breathing practice. Studies show that slow, deep breathing in which exhalation is longer than inhalation removes toxins from the bloodstream and reduces cortisol levels. Additionally, there are herbal supplements that also lower cortisol levels. Relora is a patented blend of magnolia and Phellodendron that is marketed as a weight loss supplement because cortisol also causes central weight gain in the abdomen and torso. Two Ayurvedic herbs, ashwagandha and tulsi, have also been shown to lower cortisol levels.
Additionally, supplements that support the health of eye tissues and cellular health generally may be helpful in reducing incidences of CSC. These include antioxidants, which reduce oxidative damage and inflammation, and omega-3 fatty acids which support cell membrane health and reduce inflammation. Even a simple stress-reducing activity such as walking can be helpful in eliminating CSC.
See our Retinal Support page for more information.
If you notice a difference in your vision, it is important to visit an ophthalmologist promptly, in order to prevent potentially serious damage to the eyes.