What to look out for and how to treat central serous chorioretinopathy

With central serous chorioretinopathy (CSC) on the rise, eye care providers can identify the first steps of uncovering the condition in patients, even with those who only have general complaints of distorted vision. Optometry Times sat down with William Hogue, MD, MS, of Vitreous Retina Macula Consultants to get a better understanding of the condition, and what treatment options are available.

Video Transcript

Editor's note: This transcript has been lightly edited for clarity.

Emily Kaiser Maharjan:

Hi everyone. I'm here with Dr William Hogue from Vitreous Retina Macula Consultants of New York to discuss central serous chorioretinopathy, or CSC. Welcome Dr Hogue.

William Hogue, OD, MS:
Thank you, thanks for having me.

Kaiser Maharjan:
Of course. So CSC is the fourth most common retinopathy and it's on the rise. What would you recommend the eye care practitioners look for in their eye exams to make the diagnosis?

Hogue:
Yeah, so you know, it's one of those tricky conditions that if you're just doing a dilated eye exam, you may gloss over it when you're looking at the retina, because it's not so easy to see without an [optical coherence tomography, or] OCT. But really guiding things based off of patient's complaints, a lot of times, they'll have these kind of nonspecific complaints of just general distortion to their vision. If that's the case, even if their vision is 20/20, it's a good idea to get an OCT, and if you don't have an OCT, sending the patient out to somewhere that does, so that that subretinal fluid can be identified.

Kaiser Maharjan:
Fantastic, and which patients are most at risk?

Hogue:
So it's really our male patients are more likely to get it and around the age of 30 to 40 is the peak onset, as far as age goes, and then patients who are type-A personality, which has become the classic association with central seros. So it's the patients who are very high achieving, very particular about how things are arranged. So especially being in downtown Manhattan, we get a lot of those type A personalities from Wall Street, those kinds of people. It's not necessarily associated with anxiety and clinical diagnoses of different mental health conditions, but just that kind of type A, high-strung personality in general.

Kaiser Maharjan:
That's very, very interesting. What treatments are available for CSC?

Hogue:
Yeah, so you know, most often is long as it's acute, the central serous, we just follow it in 3 to 4 months. The fluid typically resolves by then, about 85% of the time, you're going to see resolution of the fluid in that 3 to 4 to 6 month period. If the fluid is remaining, that's when we send over to our retina specialist colleagues to consider things like photodynamic therapy. For that they inject a medicine called Visudyne into the vitreous, and then use some special lasers to create a chemical reaction that helps to lower the amount of fluid. There's been some more recent look into different oral medications, ones that basically counteract the endogenous [cortico]steroids within the body to try to help, which has kind of given mixed results. Then they they will occasionally use some other different kinds of lasers in trying to reduce the amount of fluid. But this is one of the conditions that can typically, especially from like an optometrist's perspective, just be followed, especially initially, as resolution just with time is typical. But it's important to make sure that those patients stop any steroids that they're on, because that can cause it or prevent it from improving. It's more just about patient education, stress management, those kinds of things.

Kaiser Maharjan:
Interesting, and is there anything that patients can do to reduce their risk?
Yeah, so you know, avoiding unnecessary steroid use. Steroids are great, but can cause this condition, so avoiding them when possible. Other things that can cause it, actually the hair loss drug, Finasteride, has been associated. It's something that I think hass become more popular, especially recently. So that's something to keep an eye out on. A lot of the patients, especially the ones I see, are asymptomatic. I just happen to catch it because we get an OCT on basically everyone. So just making sure that you go get your annual eye exams, because you never know what will pop up.

Kaiser Maharjan:
That's really interesting. Is there anything else that you'd like to add that we haven't touched on?

Hogue:
The only other thing to discuss is the the acute central seros versus chronic central serous, kind of finding that those are really quite different kinds of conditions that require different management. So trying to determine and be aware of the different things to look out for that indicate that it could be chronic, like more changes on fundus autofluorescence, more than just a couple of [retinal pigment epithelial detachment, or] PEDs, like PEDs throughout, and then areas of [retinitis pigmentosa, or] RP damage from from prior episodes. So it's just important to keep an eye out for the signs of chronic CSC, since they require treatment.

Kaiser Maharjan:
Absolutely. Well thank you so much for taking the time to talk about central serous chorioretinopathy today.

Hogue:
Of course.

Kaiser Maharjan:
It's been a pleasure chatting with you.

Hogue:
Yeah, I appreciate it.