Monitoring and Managing Central Serous Retinopathy

by A. S. Murphy

This is an account of my experience in dealing with a CSR episode. In my case the it occured at a time when I was subject to a stressful family situation. After I was diagnosed with CSR I was concerned about my vision. I decided to make some measurements and to try to learn how to use the information to control the situation and avoid any further stress.

The application CSR Utility (CSRU) is the result of this. It is presented here in the hope that others can make use of my experience and of the measurement tool that I have developed. I found it much easier to control the situation once I had the knowledge of how my CSR was progressing.

The following information describes my CSR epsiode and the information obtained.

One day I noticed a spot had appeared in central part of the vision in my right eye. The spot diameter would have been about 4 degrees wide. In the discussion which follows this day is taken as "day number 1". After seeing an eye specialist on day number 6, I was advised to return if the spot got worse. The consultant's comment made me decide to measure the spot size on a daily basis. This resulted in the CSR Utility Spot Size tool.

On day 27 I decided to supplement the Spot Size tool with measurements of visual acuity using a Pseudo-Snellen chart presented on a computer screen. I also noticed that the long distance vision in the affected eye was improved when using my reading glasses, indicating that there was a change in focus distance. I then added a measurement of my best focus distance when wearing a particular set of reading glasses.

On day 103, during a routing hospital visit, I was advised to check my blood pressure as it was slightly high. I did this, consulted my doctor and on day 148 commenced a low daily dose of Bendroflumethiazide.

The following charts show the result of the measurements taken over a period of 200 days.

The Spot Size chart shows the angular diameter (width) of the spot starting at day number 6.

Spot Size

Notice the following:

the original leak appeared to heal on about day number 36
the 'hump' from day 68 to 75 correlates with a further stressful period
the small peak at day 86 resulted from a stressful incident the day before
the new major leak at day 118 was again caused by stress
the levelling off at day 134/135 which occured immediatley after some major dental work to cure an infected tooth
the very significant drop in spot size at day 150 which resulted from starting a course of medication for high blood pressure
the small blip at day 187 indicated another stressful day
at day 208 the spot faded to an extent that further accurate measurement was not possible

The following two charts show the visual acuity and best focus distance measeurements starting from day number 27.

Pseudo Snellen

Best Focus

Although both these graphs are a bit noisy in terms of their data, they both show a significant change starting at day 118 - the day of the second major leak. The best focus distance changed from about 60cms to 75cms very rapidly and the visual acuity as measured by the Snellen chart showed a marked change.

It was not until very near the end of the CSR episode that I formulated the method for estimating the distortion I was seeing in straight lines. For this reason, I have not collected much data regarding this paricular measurement and so this is not presented here.

I welcome feedback regarding the use of the CSR Utilty tool, particularly regarding the distortion measurement method.

My advice to others who are inflicted with a CSR incident is to monitor the situation using CSR Utility, to control and learn to live with stressful situations, to monitor blood pressure on a regular basis and plot this information in conjunction with the data obtained by CSRU.

Alan Murphy