Central Serous Chorioretinopathy: Causes and Laser Treatment

Central serous chorioretinopathy (CSR)

is a unique and increasingly common eye condition that primarily affects the macula, the central part of the retina responsible for sharp vision. While often self-limiting, CSR can lead to lasting visual issues if not properly managed. It has been notably linked to elevated cortisol levels, chronic stress, and Type A personalities, particularly among high-performing individuals in places like Silicon Valley.

Although CSR was historically more prevalent in men, newer trends indicate a more balanced prevalence between males and females, possibly due to shifts in work-life stress and healthcare awareness.

An elderly woman undergoes an eye examination using a slit lamp at an ophthalmologist's office, highlighting the importance of regular eye check-ups for vision health.

What Is Central Serous Chorioretinopathy?

Central serous chorioretinopathy involves serous detachment of the retinal pigment epithelium (RPE), resulting in fluid accumulation under the retina. This leakage causes distorted or blurred central vision and, in some cases, a central dark spot.

While some cases resolve spontaneously within 1–3 months, others persist and may cause long-term retinal damage and vision loss, making early detection and careful monitoring critical.

Causes and Risk Factors

Common triggers and contributing factors include:

• Elevated cortisol (linked to stress or corticosteroid use)

• Sleep disturbances

• Caffeine overuse

• Type A personality traits

• Male gender (historically), though now more equally distributed

Reducing these risk factors through lifestyle changes has shown to aid in recovery and prevent recurrence.

Subthreshold 532nm Laser in Central Serous Chorioretinopathy

For patients who do not improve with observation and lifestyle changes, subthreshold 532nm focal grid laser treatment is emerging as a safe, effective intervention.

A retrospective study (2008–2016) evaluated 35 eyes from 34 patients with chronic or non-resolving CSR:

Key findings:

• Visual Acuity (VA) Improvement:Mean logMAR VA improved from 0.33 ±0.15 to 0.18 ±0.05 over 9–12 months.67% of patients showed improvement on OCT and VA at the first post-treatment follow-up.

• Reduced Central Foveal Thickness (CFT):OCT scans showed CFT decreased from 394 µm to 204 µm, indicating fluid resolution.

• Microperimetry Improvements:Unlike Snellen chart alone, automated microperimetry revealed significant visual field improvement in the macular region—something not always captured by acuity tests alone.

This suggests laser-treated patients may experience functional vision improvements even when Snellen VA appears stable.

Comparing CSR Treatment Options

Depending on the stage and severity, CSR management may include:

• Observation and Lifestyle Modification(First-line for acute cases; includes stress reduction, better sleep, limiting caffeine)

• Topical Non-Steroidal Medications(Anti-inflammatory agents that may reduce retinal inflammation)

• Photodynamic Therapy (PDT)(More invasive; used for chronic or resistant CSR)

• Subthreshold 532nm Laser Therapy(Safe, non-damaging to the retina, and effective for non-resolving cases)

• Thermal Laser Photocoagulation(Previously used; now limited due to risk of central vision damage)

South Bay Retina’s Protocol for CSR

At South Bay Retina, the approach is systematic:

1. Observation Period (4–6 weeks)If it’s a patient’s first episode and visual acuity is relatively preserved, the eye is monitored while emphasizing lifestyle changes—sleep hygiene, stress reduction, diet, and avoiding caffeine, alcohol, or steroids.

2. Follow-Up Every 3 MonthsIf fluid persists or vision declines, subthreshold laser treatment is considered.

3. OCT and Microperimetry at Every VisitThese tools help assess both anatomical and functional improvement.

4. Fluorescein Angiography (IVFA) and Indocyanine Green (ICG)May be used for planning laser therapy or ruling out other conditions.

Safety and Long-Term Outlook

The subthreshold 532nm laser treatment has shown:

• No cases of CNV (choroidal neovascularization) in the study cohort

• Minimal retinal risk, making it superior to conventional thermal laser

• Consistent visual recovery and CFT reduction

It offers an excellent balance of safety and efficacy, especially for patients hesitant to undergo invasive treatments like PDT.

Conclusion: The Need for Personalized CSR Care

Central serous chorioretinopathy reflects the interaction of psychological, lifestyle, and biological factors. While many cases resolve naturally, some benefit from early intervention with safe and effective options like subthreshold 532nm laser therapy.

Further studies are needed to:

• Identify ideal candidates for laser treatment

• Determine the best timing for intervention

• Understand long-term recurrence and outcomes

For now, early diagnosis, ongoing monitoring with OCT and microperimetry, and tailored treatment plans provide the best chance for vision preservation.

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