Central serous retinopathy (CSR) can look like wet AMD.
I was referred a patient recently who had multiple injections of Lucentis (an anti-VEGF drug) for wet AMD. Her vision did not improve despite the treatment. After I carried out further investigations such as a fluorescein angiogram, indocyanine green angiogram and OCT, for her eye, I discovered that she did not have wet AMD after all. She actually had another common retinal disease called central serous chorioretinopathy (CSR).
Treatment of Central Serous Retinopathy (CSR)
The treatment of CSR is different from the treatment of wet AMD. I carried out a special laser treatment to her retina called photodynamic therapy (PDT). This involved injection a drug called verteporfin into her veins followed by targetted laser treatment to leaking blood vessels in the retina.
The laser beam activated the drug which then causes the leaking blood vessels to close up. Normal blood vessels will not be affected. After PDT treatment, one has to avoid direct contact with sunlight as the drug makes our skin sensitive to UV light exposure.
Younger but Sometimes Older Patients
Within a matter of days, the swelling of my patients retina resolved and she noticed an improvement in her vision. Although CSR is more commonly found in younger patients, it can also happen in older patients.
That is why it can be sometimes mistaken for wet AMD. CSR does not cause vision loss as severe as wet AMD and sometimes gets better by itself. That is why retinal specialists sometimes opt to watch and wait rather than treat CSR.
Stress and Other Causes of CSR
Risk factors for CSR include exposure to steroid drugs, stress, smoking, and having a Type A personality. It has always puzzled me how ones personality can affect your eye sight but studies have shown a strong association between CSR and your type of personality.
If you lead a stressful life and are always worried, it is more likely that the stress hormones in your body like cortisol are more elevated than normal. This can lead various diseases like CSR.
I guess this just means we have to take a break regularly from our busy lives and try to relax a bit more. I am looking forward to my next holiday with my family!
Kenneth Fong, M.D.
Retina Specialist
Kuala Lumpur, Malaysia
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