What is Central Serous Chorio-Retinopathy (CSCR or CSR)?
The retina is a layer of special light-sensitive tissue at the back of the eye that sends nerve impulses up the optic nerve to the brain. The macula is a very small area at the centre of the retina. It is the macula that is responsible for pinpoint vision, that allows you to read, sew or recognize a face.
In people with CSR, fluid leaks from the layer underneath the macula and lifts it off the wall of the eye, like a blister, called a ‘serous detachment’. This blister can cause distortion or blurry vision, a blind or gray spot in the central vision, and unexplained flashes of light. The leak can occasionally cause development of abnormal new blood vessels that leak blood, not just fluid.
Why did I get CSR?
The exact cause of CSR is not known. It has been associated with increased stress and steroid medications, or increased steroids being produced by your body. Patients with CSR tend to be far-sighted and they may have an unusually thick choroid, the layer surrounding the retina. It is not usually associated with other eye diseases.
If it has occurred in one eye, you are at higher risk of it occurring in the other eye.
Management for CSR
Fortunately, with the majority of cases of CSR, the recovery is quite good. Identifying stressful aspects of your life and resolving them is an important part of the management.
The vision of most patients improves spontaneously over a few months. There may be mild permanent visual changes such as decreased contrast, night vision or increased distortion.
In some cases, new detachments may develop weeks, months, or even years later. Each episode can damage the retina over time. You may need investigations and treatments outlined below if CSR does not resolve or it recurs frequently.
General Practitioner
If CSR is recurring frequently, then Dr Sharma may need to organise some blood and urine tests for your family doctor to perform. This will check whether your body has another underlying condition, and whether you are suitable for treatments.
Fluorescein Angiogram
This is a test where a special dye is injected in your arm and as it flows into the blood vessels of the eye, photos are taken. This test tells us whether there is a specific blood vessel that is leaking and causing the problem.
Oral Medications
Recent research has found that small groups of people with CSR respond to certain oral medications. This may not be suitable for everyone because it depends on the health of your kidneys and liver.
Laser
Both ‘photodynamic therapy (PDT)’ and ‘focal laser’ have been used for treatment of CSR, with good success rates. PDT laser requires a special medication to be injected first, which the Australian government does not cover unfortunately.
Intravitreal Injections
In certain types of CSR, injections into the eye have been shown to be a effective treatment.
Dr Sharma will go through in detail with you the risks, benefits and limitations of the above management options.