Macula & Retina Specialist

Central serous retinopathy (CSR) describes a condition where fluid develops in the central vision (macula) in patients of working age. It is more common but not exclusive to males. Symptoms can include blurred central vision, washing out of colours and waviness of straight lines. Steroids play an important role. This can either be external steroids in the form of steroid tablets, nasal sprays or creams or internal production of steroid (cortisol), usually due to stress.

On one end of the spectrum, is acute CSR which usually resolves within 6 months, especially when the trigger is removed. Patients often have recurrent episodes. On the other end of the spectrum, is chronic CSR which can cause significant long-term damage to the central vision and does not resolve without intervention.

CSR is now recognised to be on a spectrum of choroidal diseases called the ‘pachychoroid diseases’. Diagnostic tools available in specialist retinal clinics including fluorescein, indocyanine green and OCT angiography can help diagnosis and planning of treatment.

There can be benefit from lifestyle measures like reducing stress or improving sleep patterns as well as avoiding steroid-based medications. If required, interventions include oral medications to reduce steroid levels, micropulse laser, photodynamic (cold) laser therapy, or intravitreal anti-VEGF therapy.

Being short sighted (myopic) is associated with wearing glasses or contact lenses to improve distance vision. There are other potential implications of myopia, mainly affecting the back of the eye. Myopia is becoming increasingly common and tends to cause retinal complications in working-age individuals. These complications include retinal detachment, wear and tear changes in the central vision and leakage of blood vessels at the centre of the vision.

Retinal detachment can lead to significant visual loss, especially if the central part of the retina (the macula) detaches, and requires surgery to help improve the vision. Usually, retinal tears or high-risk retinal holes develop first. There is the opportunity to intervene with barrier retinal laser at this stage in a clinic setting to prevent fluid tracking under these retinal breaks and reduce the risk of retinal detachment formation.

Retinal tears can develop when the vitreous jelly separates from the back of the eye (posterior vitreous detachment). The vitreous jelly separates at a younger age in myopic individuals. Symptoms typically include a dramatic increase in floaters, flashing lights that persist or an area of the peripheral vision that is completely blacked out. If these symptoms develop, it is important to have an urgent ophthalmology assessment.

Retinal holes can develop in eyes that are myopic or had trauma. In the early stages, they often do not cause visual symptoms. If fluid tracks through the hole and gradually detaches the retina, patients can report symptoms of flashing lights or an area of the peripheral vision that is completely blacked out. The vitreous jelly does not have to separate for this kind of retinal detachment to develop. If you notice these symptoms, it is important to have an urgent ophthalmology assessment.

Retinal vein occlusions usually occur in patients over the age of 50 years with high blood pressure or diabetes. They can also occur in younger patients where an issue with blood flow or clotting may be the underlying cause. Therefore, as well as managing the eye disease, a physician is usually involved to try and identify and treat the underyling disease.