Central serous chorioretinopathy, often shortened to CSCR, is a retinal condition in which fluid collects beneath the retina, usually underneath the macula. The macula is the central part of the retina responsible for clear, detailed vision.
This fluid can cause the retina to lift slightly, leading to blurred, dimmed or distorted central vision. Some people notice a grey patch, altered colour perception or that objects appear smaller or further away than usual.
CSCR can occur as a single episode, but it may also recur. At The Retina Clinic London, we pay particular attention to the presence and recurrence of subretinal fluid, using advanced imaging to identify its pattern and guide treatment.
What symptoms can CSCR cause?
Symptoms vary depending on the amount and location of fluid beneath the retina.
They may include:
- Blurred central vision
- Distorted vision, with straight lines appearing bent or wavy
- A grey or darker area in the centre of vision
- Reduced contrast or difficulty seeing fine detail
- Colours appearing faded or altered
- Objects appearing smaller or further away
- Difficulty reading
- Increased sensitivity to bright light or glare
CSCR often affects one eye, although both eyes can be involved.
Any new or unexplained change in central vision should be assessed by an eye specialist.
What causes CSCR?
CSCR involves changes in the choroid, the layer of blood vessels beneath the retina.
Fluid can pass through areas of dysfunction in the retinal pigment epithelium, the layer of cells that supports and protects the retina, and collect beneath the light-sensitive retina.
The precise reason this happens is not always clear, but CSCR has been associated with several factors, including:
- Psychological or physical stress
- Corticosteroid medicines
- Disturbed sleep or obstructive sleep apnoea
- High blood pressure
- Certain hormonal or systemic health factors
Corticosteroids can include tablets, inhalers, nasal sprays, creams and injections.
Patients should not stop prescribed corticosteroid medication without first speaking to the clinician who prescribed it. Where relevant, our specialists can advise whether medication or wider health factors should be reviewed.
How is CSCR diagnosed?
At The Retina Clinic London, CSCR is assessed through a detailed consultant-led retinal examination combined with advanced retinal and choroidal imaging.
The aim is not simply to confirm that fluid is present, but to understand where it is coming from, how much of the retina is affected and whether there are features that influence the choice of treatment.
Optical Coherence Tomography (OCT)
OCT provides highly detailed cross-sectional images of the retina.
It allows us to identify and measure fluid beneath the retina and examine the condition of the macula and retinal pigment epithelium.
Because OCT can be repeated over time, it is also particularly important for monitoring the response to treatment and identifying recurrent fluid.
Fundus Autofluorescence
Fundus autofluorescence provides information about the health and function of the retinal pigment epithelium.
This can help identify areas that have been affected by persistent or recurrent disease.
Fluorescein Angiography
Fluorescein angiography uses a fluorescent dye to examine the retinal circulation and identify areas where fluid is leaking.
The pattern and position of leakage can help guide treatment decisions.
Indocyanine Green Angiography
Indocyanine green angiography, or ICG, allows the deeper choroidal circulation beneath the retina to be examined in greater detail.
This is particularly useful in CSCR because changes in the choroid are an important part of the condition. ICG can also help plan treatment such as photodynamic therapy.
OCT Angiography
OCT angiography is a non-invasive scan that provides additional information about blood flow within the retina and choroid.
It can be particularly helpful when assessing whether abnormal new blood vessels are present alongside CSCR.
Together, these investigations allow the consultant to build a detailed picture of the disease rather than relying on a single scan or finding.
Why does fluid matter?
Subretinal fluid means that the light-sensitive retina is separated from the tissue underneath it.
The amount of fluid does not always correspond directly with the severity of symptoms. However, when fluid remains beneath the retina or repeatedly returns, it can cause lasting damage to the retinal cells responsible for detailed vision. Over time, this may lead to retinal thinning or atrophy and permanent changes in vision.
For this reason, our approach is to monitor subretinal fluid closely and consider active treatment when fluid is present or recurs, rather than routinely allowing it to persist for prolonged periods.
How is CSCR treated at The Retina Clinic London?
Treatment is personalised according to the pattern of fluid, previous episodes, angiographic findings, visual function and the health of the retina and choroid.
Our approach is proactive. When active or recurrent subretinal fluid is identified, treatment may be considered promptly where clinically appropriate.
Treatment options may include photodynamic therapy, anti-VEGF injections and focal retinal laser.
Photodynamic therapy
Photodynamic therapy, or PDT, is an important treatment for CSCR and may be recommended depending on the pattern and duration of the disease.
A light-sensitive medicine called verteporfin is administered before a precisely targeted laser is applied to the affected area of the choroid.
The treatment is designed to modify the abnormal choroidal circulation contributing to leakage and encourage resolution of the subretinal fluid while limiting the effect on surrounding retinal tissue.
Fluorescein and indocyanine green angiography can be used to identify the areas of abnormal choroidal circulation and plan treatment accurately.
The Retina Clinic London has access to photodynamic therapy with verteporfin where it is clinically appropriate.
Anti-VEGF injections
Anti-VEGF therapy may also form part of the treatment pathway in selected patients with CSCR.
Anti-VEGF medicines reduce the activity of vascular endothelial growth factor, known as VEGF, which is involved in abnormal blood vessel growth and blood vessel leakage.
Their role in CSCR depends on the individual pattern of disease identified on advanced imaging. Anti-VEGF treatment is particularly relevant where CSCR is associated with abnormal new blood vessel growth beneath or within the macula. At The Retina Clinic London, it may also be considered as part of an early treatment strategy in selected cases according to the clinical and imaging findings.
Intravitreal injections are delivered directly into the vitreous, the clear gel inside the eye, allowing treatment to act close to the retina.
The response is monitored closely using OCT and other retinal imaging, with further treatment decisions guided by changes in subretinal fluid, retinal anatomy and visual function.
Focal retinal laser
Focal laser treatment may be considered when imaging identifies a suitable, clearly defined area of leakage.
The laser is directed precisely at the leakage point and is generally reserved for locations where treatment can be delivered safely away from the very centre of the macula.
Whether focal laser is appropriate depends on the location and pattern of the disease.
Addressing contributing factors
Treatment of the retina is only one part of managing CSCR.
Where relevant, the consultation may also consider factors associated with the condition, including:
- Corticosteroid medication
- Blood pressure
- Sleep disturbance or sleep apnoea
- Stress and other wider health factors
Any changes to prescribed medication should be discussed with the clinician responsible for that treatment.
Monitoring treatment and recurrence
CSCR can recur, sometimes after the retina has previously become dry.
For this reason, follow-up imaging is an important part of the treatment pathway.
High-resolution OCT enables very small changes in subretinal fluid to be identified and compared over time. If fluid reappears, the consultant can reassess the pattern of disease and determine whether further treatment is appropriate.
At The Retina Clinic London, recurrent fluid is monitored closely and may prompt further treatment rather than prolonged observation where intervention is clinically appropriate.
A specialist approach to CSCR
CSCR can look relatively straightforward on a single scan, but its behaviour can differ considerably between patients.
Understanding the condition properly requires assessment of both the retina and the deeper choroidal circulation, together with careful comparison of imaging over time.
At The Retina Clinic London, our specialist team combines detailed retinal examination with OCT, fluorescein angiography, indocyanine green angiography, OCT angiography and other advanced imaging where appropriate.
This allows treatment to be tailored to the individual pattern of disease and adjusted according to how the retina responds.
Our aim is to identify active disease accurately, address subretinal fluid proactively where treatment is appropriate, and give each patient a clear understanding of their condition and the available treatment options.
The next step
If you have blurred or distorted central vision, have experienced recurrent CSCR, or have been told that there is fluid beneath your retina, a specialist retinal assessment can establish the pattern of disease and whether treatment is appropriate.
To book your consultation, please call us on +44 (0)20 4548 5310.
We’ll be glad to guide you through the next steps.