Central Serous Chorioretinopathy


Hello my name is Richard Spaide. I’m a vitreoretinal surgeon with the Vitreous Retina Macula Consultants of New York. I’d like to talk
to you about a condition called Central Serous Chorioretinopathy. That’s
a big word. Sometimes be called it CSC or we call it Central Serous for short. It is an interesting entity that was discovered in the 1800’s and a lot of us learned
about the psychosocial aspects of this disease plus the anatomy and all the
other changes that occur over the last hundred years. Central Serous is a condition that typically occurs in men and oftentimes they seem to be stressed or
they have a lot of stress in their life. And they can develop leaks of fluid
underneath the retina, and the retina gets ballooned up by this fluid and patients get
distorted vision and decreased central vision because of this fluid. We have a number
of interesting treatment modalities based on our ideas about this disease. In
the 1920’s people started getting the idea that patients with
Central Serous Chorioretinopathy maybe had more stress or there was some kind
of factor that these patients seemed a little bit different than patients with other
ocular diseases. And this idea kept developing until early World War II where most of the patients who develop Central Serous were men. And they were men in wartime
conditions. And people put that link together that maybe stress involved in
war was somehow related to an eye disease. After the war in the 50s, the
interesting thing is that more and more women were described with Central Serous Chorioretinopathy. In the 1960’s, Doctor Malmany injected a dye called fluorescein into the eye and he looked at the fluorescein with his eye and saw that there were leaks of
fluorescein dye from a deeper layer of the eye and this caused fluid to accumulate
underneath the retina. Shortly following that, there was development of fluorescein angiography, which used film photography to record that. And they were able to look and see
leaks underneath the retina associated with this disease. Didn’t know how to treat it at
the time. So, some enterprising ophthalmologist got the idea of, well maybe we should treat those leaks with a laser and we recall right around that time was the invention of ruby laser. So, Central Serous Chorioretinopathy is the first disease ever treated with a laser and in fact it worked. So, this formed the
basis of much of our treatment through the 1980s in fact. More
recently, we’ve been treating this disease using other modalities which I’ll
talk about soon. Typically, a patient with Central Serous
will come in with complaints of decreased central vision with distortion as well.
And they may have prolonged after-images where they see green or purple images after looking at a bright light and that after- image may last for quite a bit of time.
The problem when the eye doctor looks inside the eye, we see a detachment of the retina, a detachment of the macula. One diagnostic instrument that is
very helpful for Central Serous Chorioretinopathy is a new technique called Optical Coherence Tomography. This instrument gives us cross-sectional images and we’re able to
see the detachment of the macula. We’re also able to see deeper down into another
structure called the choroid. The choroid is an area where there’s many blood vessels that are
densely packed inside the eye. We’ve discovered at the Vitreous Retina Macula Consultants of New York that the blood vessels in the choroid are too leaky and this leakage
increases the pressure inside the choroid and it and it breaks through and pushes up
the retina and that’s where the fluid comes from. Using a new form of Optical
Coherence Tomography, we show that a choroid becomes thicker with this disease. So, we have a way to follow these patients. We can look at the thickness of the
choroid and we can look at the amount of fluid underneath the retina. If the Central Serous is present for a period of time, we can treat this and we can attack the
leakiness of the blood vessels in the retina or we can do laser therapy on the leaks themselves. So, we can to detect the root of the problem by treating the
choroid. The retina flattens out and the vision generally gets better. This is still an interesting disease in that it is driven by stress. And stress can happen
in a number of different ways. Certainly, if somebody has a death in the family or moves or has the new job or something like that that’s kind of an external sort of
stress that many times is the initiating factor for development of Central Serous.
Another group of people that we see, particularly in New York, are people who
use stress as kind of a drug or adrenaline to get themselves psyched up to do a
job. And these are often very successful people and they’re under stress and they
kind of thrive on that stress but the stress comes out in different ways,
sometimes as Central Serous. So I had one lawyer, for instance, who told me that he
has a lot of stress inside and it comes out through his eyes as Central Serous.
When you talk to patients, it’s not only about their disease but also a little bit about
stress management.

8 comments

  1. I resolved my chronic central serous retinopathy problem with naproxen (quebec) aleve (canada, usa), 1x500mg every 12 hours. For me it takes me 4 to 5 days and the spots leave. Not forget to protect your stomach with pentoprazole.

  2. I have found how to lower my cortisol level that causes the CSR in the first place… I read about a research work that dr John Cryan from Ireland did, he found that lab mice being administered lactobacillus (probiotics) in their diet had a much lower level of cortisol in their system. The 2 main live bacteria in the research were " lactobacillus ruteri and lactobacillus ramnosis". After a brief search I found the right probiotics that had the right culture and strength and started using it… within 3 weeks my CSR has gone!
    I don't personally do this but I encourage you people to try… it's natural, healthy and doesn't feed the farmacopia hungry establishment. Education it's available on the web for everyone. Peace

  3. I have CSR and I'm really dismayed by how many docs I've seen (and dropped) that know nothing about it. Over the years it has flared up 3 times, and every time I have to basically teach my doctors about it before they are willing to do anything about it. Very strange.

    Spaide is like a breath of fresh air – finally a video about central serous retinopathy with actual information and content. That so-called Dr Kwang guy on another yt account should demand the $25 back for his doctorate, 'cos he's such an idiot when it comes to this subject. I can't believe the kinds of crap he is spreading about CSR that isn't even nearly true.

  4. Zero caffeine (coffee, coke, etc)
    Zero alcohol
    Min 8 hours of sleep ( sleep is the most important factor)
    Eat lots of Vitamin C fruits and vegs.
    And keep cool, no stress
    Hopefully your symptoms will be reduced to 50/50 in 2-3 weeks.

  5. I was diagnosed with this today 4/12/2019. My doctor basically gave me the exact same information presented in this video.

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