What is Central Serous Chorioretinopathy?

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Central serous chorioretinopathy (CSCR) is a retinal condition in which patients notice a discolored spot in their central vision. This spot occurs from a build-up of fluid underneath the macula, the center of the retina. CSCR has been associated with several risk factors, including male sex, the use of corticosteroid medications, hypertension, alcohol use, gastroesophageal reflux disease, pregnancy, and use of psychotropic medications. It is also traditionally but controversially associated with psychological stress and the Type A personality.

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CSCR most often occurs in young and middle-aged adults typically between the ages of 20-50 years. For unknown reasons, men develop this condition more commonly than women. Vision loss is usually temporary but sometimes can become chronic or recur. CSC is typically a self-limiting disease that goes away on its own without treatment. Visual recovery usually occurs within a few weeks to a few months and vision often returns to normal or near normal.

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How is it diagnosed?

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CSCR is diagnosed by your eye specialist through a clinical exam and photos and scans of your retina. Optical coherence tomography (OCT) is a retinal scan that is very helpful in diagnosing CSCR. It gives an image of the retina at the microscopic level. This makes it possible to identify very small pockets of fluid in acute or chronic CSCR.

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Fluorescein angiography is a test in which a dye is injected into a patient’s arm vein. The dye circulates through all blood vessels of the body including the eye. Pictures are then taken of each eye to detect leakage of the dye beneath the patient’s retina. This test, along with OCT, allows your doctor to confirm the diagnosis of CSCR. Generally, only OCT is necessary, but an angiogram is done if treatment is required to guide the location of laser treatment.

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How is CSCR treated?

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Depending on the severity and timeline of your symptoms, your doctor will choose the best treatment option, which often begins with a trial of observation. If the fluid does not go away on its own, your doctor may recommend treatment. Several therapies have been used in the past to treat chronic CSCR, including thermal (hot) laser treatments, eye injections, or “cold laser” called photodynamic therapy. Photodynamic therapy is the most commonly offered treatment.

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What is Photodynamic therapy (PDT) with Visudyne?

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With photodynamic therapy, a drug called verteporfin (Visudyne) is injected into the arm. It travels throughout the bloodstream to all the blood vessels in the body including the eye. The retina is then exposed to a low-energy laser beam that selectively destroys the abnormal vessels without damaging the overlying retina activating the verteporfin dye. It may also prevent future recurrences in some eyes.  More than 1 treatment may be necessary, at least 3 months apart.

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What do I need to prepare for the laser?

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Increase fluids 24 to 36 hours before your appointment. Do not have caffeine the day of your appointment. Please bring the following items with you to the hospital: dark sunglasses, gloves, a wide-brimmed hat, a long-sleeved shirt, and pants. Your skin should not be exposed to direct sunlight for 2 days after the treatment. You will need to reschedule any dental or other appointments that use bright halogen lighting until 3 days after treatment (the light-sensitive period).

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The appointment at the hospital will take 3-4 hours. Please feel free to bring snacks and something to do (book or iPad).

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What can I expect when I have a laser?

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A technician will check your vision, dilate your pupils and perform an OCT of the retina.  You will then have a fluorescein angiogram to determine the exact location of the leakage.  The Fluorescein tints your skin a yellow for about 6 hours. You may notice your urine is darker yellow for the next 24 hours. Tell your nurse if you have any allergies, hay fever, or asthma. The nurse will then infuse a light-activated drug called Visudyne into a vein in your arm. This infusion takes 10 minutes. Five minutes after completing the infusion the doctor will instill an eye drop to numb the surface of your eye and a contact lens will be placed on the cornea.  The lens acts to focus light on the retina and keeps the eyelids open.

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The laser will be shone onto the affected area of the retina for 83 seconds. The laser activates the drug within the abnormal blood vessels, causing them to close. The laser does not cause any heat so it does not burn the eye. Adverse reactions to PDT may include skin reactions at the injection site, blurred vision, and visual defects which are usually temporary.

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What care is required after the PDT?

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You must arrange to have a driver to take you home.  Do not drive yourself.

After the treatment, avoid exposure to direct sunlight or bright light for two days. If you are near a window in your home, keep the curtains closed to block out direct sunlight. If you really need to go out during daylight hours within the light-sensitive period, wear a long-sleeved shirt and pants, gloves, socks and shoes, sunglasses, and a hat. Other sources of bright light should also be avoided including tanning salons and halogen lighting in homes and offices (such as bright halogen reading lamps).  You should not, however, stay in the dark during the light-sensitive period. Exposing your skin to indoor light will help to inactivate the drug in the skin. Note that UV sunscreens are not effective in protecting against photosensitivity reactions. After the light-sensitive period, you may resume normal outdoor activities without any special precautions.

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