What is the best treatment for central serous retinopathy?

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The eyes are a pair of blessings that we often take for granted. We use them for everything, from navigating our ways, recognising the people we meet, reading and learning, seeing the wonders of the world and a major enhancement for our survivability. We barely appreciate the gift of vision until something goes wrong.

The eye is a complex organ made of intricate structures that are arranged in perfect order to enable sight into our lives. Generally, it comprises three layers, the inner retina, the middle choroid and the outermost sclera, the white part of the eye. The light that enters through our pupils gets focused with the help of the aqueous and vitreous humour. The focused light lands on the retina get processed into electric signals and brought to the brain to get interpreted. Defects in any of these pathways may result in change or loss of vision.

There are many diseases of the eye, however, we are going to discuss central serous retinopathy (CSR) or also known as central serous chorioretinopathy (CSC). To know about the best treatment for central serous retinopathy, we need to understand the disease a little bit deeper and the statistics of central serous retinopathy recovery.

Central serous retinopathy, from here on referred to as CSR, is a condition when fluid leakage originating from the choroid accumulates under the retina forming a kind of bump in its supposedly smooth normal contour. This disrupts a layer in the retina called the retinal pigment epithelium (RPE). This disruption causes visual distortion.

The condition often affects adult men from 20 to 60 years of age, but women can also be affected. There are many recognised risk factors for CSR, among them are:

  • Stress which is a major risk factor
  • Frequent steroid use, whether by intravenous, oral or inhalation
  • Autoimmune diseases
  • pylori infection which is the same organism causing peptic ulcer.
  • Type A behaviour which portrays aggression and competitiveness
  • Hypertension
  • Sleep disturbances

CSR is characterised by symptoms such as:

  • Frequently affecting one eye, but bilateral involvement is not uncommon
  • Altered central vision, either distorted, dimmed or blurred
  • Straight lines in the affected eye may appear bent
  • An object of focus may seem further away or smaller than they are
  • Discolouration of the white object to a brownish tinge or duller in colour

Regarding its treatment, it is important to note that the disease is self-limiting in 60% of the cases. Meaning to say that it doesn’t progress to more serious complications and it resolves spontaneously among the said case percentage. Therefore, as a general rule of thumb, only chronic cases (CSR that persists for more than 4 months), recurrence, and occupational or urgent need of sight restoration may be the only case exceptions to prompt treatment.

In CSR, surgical approach fares better than medications which lack evidential studies. There are two different surgical approaches;

1) Photodynamic therapy (PDT)

This method uses light, injected photosensitizing drug and molecular oxygen to induce cell death. Data shows that this therapy has a faster rate of fluid reabsorption and vision restoration.

With the enhanced technique of reduced fluence PDT, greater sensitivity can be achieved, hence maximising efficiency and minimising surrounding tissue destruction. This has made PDT with reduced fluence a current standard in treating CSR.

2) Laser photocoagulation

This method uses laser beams to coagulate or destroy small areas of retinal tissue.

Studies have shown that this method shortens the disease course and prevents recurrence. However, the major downside is it doesn’t seem to improve the final visual outcome.

As a conclusion, central serous retinopathy is, most of the time, temporary and will resolve spontaneously. From our part, we can minimise the chances of getting the disease by actively reducing the risk factors. If you are having concerns over the change of vision you might be having, it is always best to consult your doctor and get yourself checked.