What is Central serous chorioretinopathy?

Central serous chorioretinopathy (CSCR) is characterised by a fluid “blister” under the central retina (the macula) – the area of sharp central vision. This is due to a disturbance to specialised cells called the RPE (retinal pigment epithelial cells) that form a barrier between the retina and the underlying blood vessel layer, called the choroid. In most cases these are abnormally distended (known as pachychoroid). Symptoms include blurred vision or distortion (straight lines or objects seeming curved).

The exact factors that cause an attack of CSCR are uncertain. However, there are important predisposing risk factors, particularly pachychoroid and the use of corticosteroid medications (including inhalers, creams and tablets), but others include stress and probably genetic factors.

Diagnoses involves a thorough eye assessment including detailed history, checking the vision and examination of the retina after dilating eye drops. These drops will blur your vision and increase glare for a few hours. You are strongly discouraged from driving home after the assessment.

An Ocular Coherence Tomography (OCT) is performed to identify the fluid under the retina, as well as detailed structural changes that can occur secondary to CSCR. You may also have an OCT-A (OCT- angiography), which is a detailed scan that looks for any abnormal blood vessel growth.

A Fundus fluorescein angiography may be indicated to identify an area of leakage in your retina. Fluorescein angiograms have been performed for over 30 years and is proven to be safe and well tolerated. The procedure involves injecting fluorescein dye into a vein in the back of the hand or in the bend of the elbow joint. Once the dye is injected,  a series of photos are acquired to document the dye circulating inside the eye, for a period of 5-10 minutes.

The information found through these investigations will help your doctor to accurately diagnose the condition and devise an individual treatment plan.

In most cases, the occurrence of CSCR is acute and resolves spontaneously within 3-4 months.  If there are any of the known trigger factors (such as steroid ointment or inhalers) they should be avoided , if medically appropriate.

In some patients, the condition can last longer than 6 months, or  recurrent flare-ups of fluid occur, that can lead to a permanent visual deteriorationIn these cases, treatment is recommended by the doctor.

Currently, there are no licensed or approved treatment options for CSCR. Traditional laser can be used carefully in cases where the leak is far from the central macula and another option is a photosensitising drug (Visudyne) that shrinks the choroidal vessels; but this dye has been out of production in Australia and is also very expensive.

A unique laser (2RT MedOne®) was developed to delay the progression of intermediate Age related Macular Degeneration (AMD) (assessed in the LEAD study) and has been extensively researched both in the laboratory and in patients. This laser produces an ultrashort (3-nanosecond) energy pulse that is specifically absorbed by the RPE and spares the photoreceptors. Critically it does not cause scar formation as does traditional retinal laser.

Retinology Institute lead a “pilot” study using the 3ns 2RT laser and the outcomes were particularly beneficial in many cases of CSCR. In early 2023, Retinology Institute will be involved in an interventional study with the Centre for Eye Research Australia (CERA), to definitely evaluate the effectiveness of subthreshold 3ns laser in patients with non-resolving CSCR.