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Central Serous Chorioretinopathy (CSCR)

What is CSCR?

Central Serous Chorioretinopathy (CSC) or (CSCR) occurs when fluid accumulates below the  layers of retina, resulting in distorted vision. This fluid often leaks from a tissue layer beneath the retina, known as the choroid.

The cell layer separating the choroid from the retina is called Retinal Pigment Epithelium (RPE).

In a healthy eye the retinal pigment epithelium works like a pump which remove the fluid from retina layers. If doesn’t function properly fluid will accumulate below the retina layers, leading to visual distortion and a small detachment.

CSCR usually occurs in one eye, but some people have the condition in both eyes.

What are the symptoms of CSCR?

The symptoms of CSCR may include:

Who is at risk?

  • Men aged between 30 - 50 years old are more likely to have CSCR than women.
  • Stress is also a major risk factor. It is well documented that those under stress pose a higher risk of developing CSCR.

Other common risk factors for this condition include:

  • Using steroids: whether inhaled, injected or orally
  • Sleep disturbances such as sleep apnoea (breathing interrupting sleep) or insomnia (difficulty sleeping)
  • pylori (Helicobacter pylori) infection (a bacterial stomach ulcer infection)
  • Use of PDE5 (phosphodiesterase-5 inhibitor) medications: such as Viagra, Cialis, Levitra
  • Hypertension or high blood pressure
  • Autoimmune Diseases: such as Lupus
  • A person who has organ transplant
  • People with ‘type A’ personality. ‘Type A' behaviour is described as anxious, competitive and outgoing, ambitious, rigidly organised, highly status-conscious, impatient, proactive, and concerned with time management. People with 'Type A’ personalities are often high-achieving workaholics.
  • Cushing syndrome (a disorder with elevated cortisol or stress hormone levels)

How do we diagnose CSCR?

The ophthalmologist will put dilating eye drops to widen the pupil to see inside the eye. The doctor will take special photographs or scans of your eyes which precisely shows all the layers of the retina called an OCT scan. This machine will scan the back of the eye and give a 3D images of the retina. The test will measure the retinal thickness and identify swelling in the retina. A newer model of this device called OCT angiogram can check the status of blood vessels without use of dye or injection and Optimal Vision is proud to be equipped with this advanced technology.

In some instances they may perform further tests known as a fluorescein angiography which reveals leaking blood vessels in your eye. During the fluorescein angiography, the ophthalmologist will inject a dye into a vein in your arm. This dye will travel through all of your veins, (including the retinal veins). The dye will show abnormal blood vessels in your eye to diagnose central serous chorioretinopathy.

How do we treat CSCR?

In most cases, CSCR clears within a month or two without treatment. The ophthalmologist will examine your eyes for early detection and to check if the fluid is clearing during this period. As well as to make sure the leak is not due to other eye forms of retinal disease. Sometimes, severe leakages or vision loss may occur. This may require a type of laser treatment called PDT (Photo Dynamic Therapy), oral medications, or thermal or Micro pulse laser treatment to seal the leaking blood vessel and restore your vision.

CSCR treatment options:

1. Photodynamic therapy (PDT)

Photodynamic therapy (PDT) constitutes a type of treatment utilising a 'cold laser.' This procedure involves the application of a non-toxic, light-sensitive dye. Infrared light activates the dye molecules, halting the leakage of fluid in the retina. As a result, approximately 80% of eyes experience the removal of retinal fluid after one to two treatment sessions, leading to a reduction in symptoms such as distortion and an enhancement in vision. Nonetheless, it is noteworthy that not all patients regain their vision despite the successful removal of retinal fluid. It is essential to acknowledge that PDT carries inherent risks, with an estimated 1% risk of vision loss, and not everyone is deemed suitable for this treatment.

2. Conventional laser:

If the origin of the retinal fluid linked to Central Serous Chorioretinopathy (CSCR) is distant from the central macula, this treatment alternative could be contemplated.

3. Micro-pulse laser

This involves utilising a low-power laser, administered in brief pulses to address the leaking area and resolve the retinal fluid issue. However, recent research indicates that this treatment is less effective compared to PDT.

4. Oral medications

Recent research has indicated the efficacy of specific tablets in reducing fluid in Central Serous Chorioretinopathy (CSCR). Eplerenone and Spironolactone, both mineralocorticoid inhibitors commonly prescribed for lowering blood pressure or treating heart failure, have demonstrated symptom improvement in some CSCR patients, although conflicting results exist in other studies. Ongoing research is underway to assess the role of these treatments. It's important to note that individuals undergoing this treatment may experience side effects, including alterations in blood salt (potassium) levels that require monitoring. Your doctor will discuss potential side effects, which can vary by drug, during the clinic consultation.

Most people who experience CSCR regain vision without treatment, but their vision may not be as good as before. About 50% of patients who have CSCR may have recurrences, meaning the condition may happen again.

Having regular follow-up eye exams is important to detect fluid accumulation, which undetected or unmonitored may cause permanent vision loss.

You can visit Optimal Vision for routine eye exams or call us on 020 7183 3725 to schedule an appointment for your eye exam.

Dr Amir Mani - Specialist refractive surgeon

One of the most experienced refractive surgeons in London

Dr Mani has performed more than 20,000 ophthalmic procedures, including LASIK, LASEK, PRK, Femto Cataract, RLE, Lens ICL and Phakic IOL Surgery

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