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.