CSR Prognosis

I was diagnosed with Central Serous Retinopathy 2 months ago, after my right eye became extremely blurry after being exposed to a great deal of stress and large amounts of coffee. I have visited 2 retinal specialists, 1 ophthalmologist and 1 optometrist since affected by this condition to ensure the diagnosis was correct. However, all eye doctors seem to agree that I will regain 100% eye acuity in the affected eye, despite the information about the disease found on your web site. Unfortunately, I have not been able to contact other patients affected by this disease, for I cannot find a suitable forum online to read and learn about other patients. I would appreciate if you could provide me with a link to a forum where I can read stories about CSR affected patients. I am extremely concern about my vision acuity, for I used to have 20/10 vision (with corrected lenses) before CSR. However, my right eye is currently at 20/20 but I have problems driving at night and the clarity of the objects around me are just not the same... Are there any reported cases of patients with 20/10 vision acuity (pre-CSR) patients regaining their vision 100% after CSR? What can I realistically expect from this condition, for thus far all I have heard are good wishes, but nothing concrete?

Answer:

Thank you for your inquiry regarding Central Serous Retinopathy or CSR. I appreciate your frustration with this difficult problem and empathize with your struggles. As you probably know, CSR is not an uncommon disorder resulting from improper regulation of fluid in the tissues under the retina. It was originally described by a physician named Albrecht von Graefe in 1886. Our understanding of the disease was further broadened 100 years later by Dr. Maumenee who used fluorescein angiography to prove that the fluid accumulating under the retina originated from the choroidal vascular network. CSR usually affects males ages 25 to 55 and has no predilection for race. Patients describe symptoms just as you encountered with an acute onset of blurry vision, usually in one eye only. Fortunately, the majority of CSR cases are self limited with a duration of six weeks. The prognosis is overall quite good with 90% of patients regaining 20/30 visual acuity or better. Further studies have shown that although the visual acuity remains high in most patients, often the affected eye may have a reduction in contrast sensitivity. I suspect that is what you are encountering at the moment. A variety of treatments have been studied for this disease including thermal laser photocoagulation and photodynamic therapy. Overall, most retinal surgeons will withhold invasive measures unless symptoms have persisted for over 4 months. This is for many reasons, but mainly because most people get better on their own and laser treatment can have side effects such as permanent spots or scotomas in the visual field. In addition to this, most studies have shown us that while visual function sometimes returns quicker with laser treatment, the long term visual quality is the same for treated and non-treated eyes. One main aspect of treatment is to minimize aggravating factors. The big ones are hypertension, stress, steroids (even topical steroidal ointments and inhalers if possible), smoking, alcohol use, some types of antibiotics and allergic respiratory disease. If you find a way to avoid stress, please let me know. I am pleased to know that your vision remains at a high level of function (although not perfect). This is promising and predicts that you are likely to avoid long term visual problems that occur in 5-10% of patients. Regarding your specific questions: "Are there any reported cases of patients with 20/10 vision acuity (pre-CSR) patients regaining their vision 100% after CSR?" There are several cases of "complete visual recovery". But again, remember that vision is a complicated, multidimensional perception that is difficult to measure. We try to make objective recordings of visual acuity, but contrast sensitivity and color have much to do how we perceive the world visually. I would not be surprised to hear that a patient that recovered 20/20 vision after CSR was not completely pleased with their quality of vision. "What can I realistically expect from this condition?" You have a 90% chance of retaining 20/30 vision or better. It is unlikely that you will experience a recurrence, but it does happen. These are the odds and there is no crystal ball, but based on your case I would anticipate that you will recover excellent vision in your right eye.