The eyes are a pair of blessings that we often take for granted. We use them for everything, from navigating our ways, recognizing 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 intricate structures of the eye, arranged in perfect order to enable sight in our lives, make it a complex organ. Generally, it comprises three layers: the inner retina, the middle choroid, and the outermost sclera, the white part of the eye. The aqueous and vitreous humor help focus the light that enters through our pupils. The retina receives the focused light, processes it into electric signals, and sends it to the brain for interpretation. Defects in any of these pathways may cause a change or loss of vision.
There are many diseases of the eye; however, we are going to discuss central serous retinopathy (CSR), 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 numerous recognized risk factors for CSR, including the following:
- Stress is a major risk factor.
- Frequent steroid use, whether by intravenous, oral, or inhalation
- Autoimmune diseases
- The pylori infection is the same organism that causes peptic ulcers.
- Type A behavior displays aggression and competitiveness.
- Hypertension
- Sleep disturbances
CSR is marked by symptoms such as:
- The condition often affects 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.
- The white object becomes discolored, taking on a brownish tinge or duller color.
In terms of treatment, it is important to note that the disease is self-limiting in 60% of cases. This implies that the disease doesn’t escalate into more severe complications, and it resolves on its own within the specified 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, the surgical approach fares better than medications, which lack evidential studies. There are two different surgical approaches:
1) Photodynamic therapy (PDT)
This method uses a 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.
The enhanced technique of reduced fluence PDT can achieve greater sensitivity, thereby maximizing efficiency and minimizing surrounding tissue destruction. As a result, PDT with reduced fluence is now the standard for 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 that it doesn’t seem to improve the final visual outcome.
In conclusion, central retinopathy is, most of the time, temporary and will resolve spontaneously. From our part, we can minimize the chances of getting the disease by actively reducing the risk factors. If you are concerned about the change of vision you may be experiencing, it is always best to consult your doctor and get yourself checked.