Author Affiliations: Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute (Drs Yzer, Fung, Barbazetto, Yannuzzi, and Freund) and Department of Ophthalmology, Columbia University (Drs Yzer, Barbazetto, Yannuzzi, and Freund), New York.
Central serous chorioretinopathy (CSC) is typically seen in hyperopic or emmetropic eyes,1 most of which have a thickened choroid.2We describe 6 eyes of 6 patients with CSC and significant myopia (Table and Figure). All eyes had a thickened choroid relative to their refractive error as measured by enhanced-depth imaging spectral-domain optical coherence tomography (Heidelberg Spectralis HRA + OCT; Heidelberg Engineering, Inc). No patients were receiving steroids.
Figure. Central serous chorioretinopathy in myopic eyes. A, Color photographs of the affected eyes of cases 1, 2, and 3 (from left to right). There are granular retinal pigment epithelial changes in the maculas of all 3 eyes and an absence of funduscopic features of myopic degeneration. B, Fundus autofluorescence imaging of the same eyes. Macular hyperautofluorescence and hypoautofluorescence changes are consistent with central serous chorioretinopathy. C, Enhanced-depth imaging spectral-domain optical coherence tomography of the same eyes demonstrates subretinal fluid. In each case, subfoveal choroidal thickness is high for the degree of myopia.
The diagnosis of CSC in 6 patients with moderate to high myopia was confirmed by clinical examination, fluorescein angiography, indocyanine green angiography, fundus autofluorescence imaging, and spectral-domain optical coherence tomography. Choroidal thickness was measured subfoveally using enhanced-depth imaging spectral-domain optical coherence tomography.
The clinical information as well as the choroidal thickness measurement and expected choroidal thickness are summarized in the Table. In each of the 3 eyes in which an expected choroidal thickness calculation was appropriate, the expected choroidal thickness was less than the measured thickness.
In a study of 28 eyes with CSC, the mean (SD) subfoveal choroidal thickness was 505 (124) μm.2 This contrasts with a mean (SD) subfoveal choroidal thickness of 287 (76) μm in normal eyes.4 Although choroidal thickness decreases with age in normal eyes, the same pattern may not hold for patients with CSC.2,4
Our 6 eyes with CSC are unusual in that they were all myopic. With the exception of patient 6, the choroidal thickness of our cases would not normally be considered high for emmetropic eyes. However, it is high for myopic eyes. In a study of 31 patients with high myopia (mean refractive error, −11.9 diopters), the mean subfoveal choroidal thickness was 93.2 μm.3 A regression analysis suggested a decrease in subfoveal choroidal thickness of 7.84 μm per diopter of myopia in eyes with no history of choroidal neovascularization.3
These cases remind us that CSC can occur in myopic eyes. In the absence of a neurosensory detachment, the diagnosis of CSC can be made based on history, fundus appearance, fundus autofluorescence imaging, and measurement of choroidal thickness. In myopic eyes without a neurosensory detachment, CSC may be missed when axial length–related choroidal thickness differences are not considered. Awareness of thin choroids in “normal” myopic patients would allow for the recognition of “thick” choroids relative to refraction in eyes with CSC.
Correspondence: Dr Freund, Vitreous Retina Macula Consultants of New York, 460 Park Ave, Fifth Floor, New York, NY 10022 (firstname.lastname@example.org).
Financial Disclosure: None reported.
Funding/Support: This work was supported by The Macula Foundation, Inc, and Stichting Wetenschappelijk Onderzoek Oogziekenhuis Rotterdam, Rotterdamse Blindenbelangen, Stichting Blindenhulp, Gelderse Blinden Stichting, Landelijke Stichting voor Blinden (Dr Yzer).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.