In The Blink Of An Eye

That’s how long it can take for your vision to change when you have CSR.

I noticed the flare up about six weeks ago. I was actually waiting for it because I knew it was coming, and I figured it would be big. I had gone through a pretty stressful period where life was throwing nothing but shit at me from every direction. Like numerous times before, I was able to feel the stress in my eyes, as though the pressure was building up inside my eyes and they were about to pop out of my head at any moment.

Given the length and level of stress I was feeling I was fully expecting to wake up one morning and see nothing but a grey circle in my central vision. When it did finally hit it was almost anti-climactic, and while it was noticeable it was just another episode of CSR. I had an OCT done and the was a small fluid buildup. I had certainly experienced worse, and after about a month or so it seemed to be slowly resolving.

An almost imperceptible moment.

Sometimes when you have chronic CSR, you will notice your vision has changed upon waking. Every once in a while a flare up will occur during waking hours, and the change in vision can be sudden and abrupt. This is what happened to me late last week as I noticed my vision deteriorate over a period of about 10-15 minutes. When it happens it almost doesn’t seem as though anything is changing, so it’s hard to pin down a precise moment that it happens. You just notice that your vision was normal a moment ago, and now it’s not.

I could tell that a large buildup of fluid had quickly taken place because it affected my entire central vision. It still seriously affected right at this moment. What I began to notice more this time was the wavy lines. Sometimes the way the fluid is built up beneath the macula, the area of central vision, that it will distort it in such a way that straight lines will begin to appear wavy.

It will typically only affect the vision in one eye, and if it is your dominant eye then you’re going to be in for a fun time for the next few weeks or months. The best way to describe my vision right now would be like this, it’s like going into a dark room after being in the sun for an hour or so. There’s a bright spot in the middle of my vision that is like the one you see after doing this, only instead of clearing up in about a minute or so, I now have it all the time. I see the bright spot every time I blink now, and find that I can see things easier by using my peripheral vision.

The challenges.

Reading a book or the newspaper is out of the question at the moment, the printing is simply too small and blurry. I have to set up my laptop so that the screen is on 175% magnification and find it is easier to read text in high resolution mode. Lighting is also important as I now have to use a light to illuminate the keyboard. In certain conditions the keyboard is only a swipe of grey keys.

Sunglasses are a must when going outside when it is sunny and if there is snow on the ground, like we had here over the week-end, things can be quite miserable for you if you don’t have a good pair of shades. I also wear an eye patch to help me focus clearer, especially when trying to read. Having disrupted stereo vision when you have CSR can be annoying and leaves me with headaches. I have to be careful about wearing it for extended periods since this can cause problems of its own, and I want to hold onto the visual acuity that I have left.

Oh ya, be prepared for a little eye-strain and some headaches. Be sure not to over do things when reading, pace yourself and take frequent breaks.

Who does CSR affect the most?

The disease presents itself primarily in middle-aged males between the ages of 30-50. Women have made up a minority of the cases though the numbers may be higher than first thought based upon anecdotal evidence. However a 2013 study in Taiwan showed that two-thirds of patients were male.

The study also found a link between the use of anti-anxiety medication and CSR, however this was only found in males. The use of anti-anxiety medication would not be unusual in many of these patients, since it would likely be used in the treatment of stress, which has been shown to be a leading cause of idiopathic CSR. An idiopathic condition is one in which the cause is unknown. For those whose CSR has been caused by taking steroid medications, the cause is known and thus it is not idiopathic in these instances.

Pregnant women are also more at risk for developing CSR, as are people with Cushing’s Disease, a disorder which causes the adrenal glands to overproduce the steroid hormone cortisol. Cortisol is also known as the stress hormone, as the body produces it during times of stress.

Excerpts from the article:

The mean annual incidence rate of idiopathic CSCR among males (0.27‰) was about 1.74-fold higher than that among females (0.15‰) in our study, and the male/female ratio is lower than the reported ratio of 5.85 in a previous population-based study [18]. Consistent with published literature, CSCR occurred most frequently in the middle-aged males, with a peak incidence at an age between 35 and 39 years (0.44‰) in our study. However, the mean annual incidence rates of females were relatively stable across all age groups when compared to those of males, and the typical pattern of middle-aged predominance shown in men was absent in women. The available data on CSCR in women is limited. 

In the present study, exposure to anti-anxiety drugs had an interaction with gender and was significantly associated with idiopathic CSCR among males only. Psychological stress and Type A behavior pattern have been implicated as contributing factors to the development of CSCR [4]. Conrad et al disclosed that CSCR patients were more stressed because of inadequate coping strategies [22]. In another case-control study, an increased use of psychopharmacologic drugs was identified as the independent risk factor for CSCR development [8]. Stress stimuli may increase secretion of cortisol and epinephrine, and these stress responses are more evident in males than in females 

Conclusions
The present study provides large-scale, population-based evidence to estimate the incidence of idiopathic CSCR among adults in Taiwan. We found that the mean annual incidence of idiopathic CSCR among males was around 1.74-fold higher than that among females, and that exposure to anti-anxiety drugs was significantly associated with idiopathic CSCR among males. The difference in epidemiology of idiopathic CSCR between genders is still not well understood and further studies are warranted.

Epidemiology of Idiopathic Central Serous Chorioretinopathy in Taiwan, 2001–2006: A Population-based Study
Der-Chong Tsai, ^{1 , 2} Shih-Jen Chen, ³ Chin-Chou Huang, ^{4 , 5 , 6 , 7}Pesus Chou, ¹ Chia-Min Chung, ⁸ Po-Hsun Huang, ^{5 , 6 , 9}Shing-Jong Lin, ^{5 , 6 , 7 , 9} Jaw-Wen Chen, ^{4 , 5 , 6 , 7} Tseng-Ji Chen, ^{11 ,12} Hsin-Bang Leu,^{# 5 , 6 , 9 , 10 , *} and Wan-Leong Chan^{# 6 , 10}
Mingguang He, Editor

Treatment.

To a large extent, there really isn’t much that can be done to treat CSR. Laser or photodynamic therapy can be employed to seal leaks in blood vessels, but there are limits to what can be done depending on the location of the retina that is involved. Laser therapy also brings with it the risk of doing further damage to the macula, thus producing blind spots.

Obviously not taking steroid medications is important, but so is trying to reduce the amount of cortisol your body produces due to stress. Finding effective ways of dealing with your stress is critical in dealing with CSR. Explore talk therapy, start doing yoga, meditate, be sure to take some time for yourself everyday, these are all thing that can help to alleviate one’s stress levels.

Proper diet and rest are also crucial for reducing stress levels, so be sure to eat a healthy balanced diet and get plenty of sleep at night. I know personally that lack of sleep can go a long way towards setting off an episode, so proper rest is very important.

So now what?

I’m going to continue doing research on CSR, and if and when I find anything of importance to share I will do so. In the meantime, all I can do is wait this out, just like a lot of others out there. Now if you will excuse me, I’m going to meditate. Namaste.

D.B.