Central Serous Retinopathy: Common causes, presentation and adjunctive nutritional management

James Meschino, DC, MS, ROHP

Central serous retinopathy (CSR), or central serous chorioretinopathy (CSC), is an eye diseasewhich causes visual impairment. The condition is often temporary, usually affecting only one eye. It primarily affects males between 20 to 50 years of age, but may also occur in women (1,2). The principle abnormality involves leakage of fluid under the retina that tends to accumulate under the central macula. This is the portion of the retina that provides the clearest, most distinct vision. Thus, fluid accumulation under the macula distorts one’s visual capacities, resulting in blurred vision. A blurred or gray spot in the central visual field is common when the retina is detached in this manner.Unfortunately, reduced visual acuity may persist after the fluid has disappeared (1).

High Cortisol Levels are a Common Cause of CSR
CSR has been associated with the use of cortisoland corticosteroids drugs (e.g. prednisone). Patients presenting with CSR often have higher blood levels of cortisol (3). Cortisol is a hormonesecreted by the adrenal gland, often in response to stress. As such, chronic stress tends to cause a persistent elevation in blood cortisol levels.  There is extensive evidence to show that the administration of corticosteroid drugs (e.g. cortisone, prednisone), which are commonly used to treat inflammatory conditions, allergies, skin conditions such as eczema, and even certain eye conditions, can trigger CSR, aggravate CSR, and/or cause a relapse of CSR (4,5,6). A study published in Archives of Opthalmology in 1993 showed that of 60 persons with Cushing’s syndrome, a condition characterized by high cortisone levels, CSR was discovered in 3 of the patients, or 5% of Cushing’s patients (7).

Nutrition and Lifestyle Management of CSR
There are standard and experimental medical treatments for CSR (medication, hot laser, cold laser, photodynamic therapy), but patients often express an interest in adjunctive nutritional measures they can adopt to help reverse the condition and/or prevent a relapse. Based on the available information I suggest that the patient take a supplement that provides adrenal adaptogens, which have been proven to decrease the secretion of cortisol from the adrenal cortex when individuals are under acute or chronic stress. The adaptogens I recommend include a combination supplement that includes Rodiola, Schisandra and Ashwaghanda, along with certain B-vitamins, Vitamin C and zinc. Although licorice root and ginseng are also good adaptogens they pose concerns with respect to blood pressure elevation, bleeding disorders, drug-nutrient interactions, photosensitivity dermatitis and other potential adverse side effects (8-18).

Some anecdotal evidence suggests that supplementation with the carotenoids, lutein and zeaxanthin, may assist in healing of CSR, as they have been shown to be helpful in cases of macular degeneration. My preference would be to provide the patient with a high potency multiple vitamin and mineral (containing Vitamin C – 1000 mg, Vitamin E – 400 IU, Selenium – 200 mcg, Beta-carotene – 15,000 IU, Zinc – 15 mg) as a foundation supplement, as these antioxidant dosages have been shown to help stabilize macular degeneration (19).  I would then add a supplement containing 20-40 mg of lutein as a separate supplement (most lutein supplements also contain zeaxanthin). Lutein and zeaxanthin are important antioxidants in the macula lutea, and have improved outcomes for patients with macular degeneration, as stated previously (20, 21).  However, vitamin C, vitamin E, beta-carotene, selenium and zinc have also been shown to be important retinal antioxidants (19).

You can view my previously published paper on the subject of adrenal adaptogens and their effects on blood cortisol levels at http://chiroweb.com/print_friendly.php?pr_file_name=http%3A%2F%2Fchiroweb.com%2Fmpacms%2Fdc%2Farticle.php%3Fid%3D55235%26no_paginate%3Dtrue%26p_friendly%3Dtrue

You can view my previous published paper on antioxidants and eye diseases at http://www.chiroweb.com/mpacms/dc_ca/article.php?id=15062

References:

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2. QUILLEN D. A., GASS J. D. M., BROD R.D., GARDNER T. W., BLANKENSHIP G. W. and GOTTLIEB J. L. ; (1996). “Central serous chorioretinopathy in women”.Ophthalmology103 (1): 72–79.
3. Garg SP, Dada T, Talwar D, Biswas NR (November 1997). “Endogenous cortisol profile in patients with central serous chorioretinopathy”.Br J Ophthalmol81 (11): 962–4.
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6. FernándezHortelano A, Sádaba LM, Heras Mulero H, GarcíaLayana A (2005). “[Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids]” (in Spanish; Castilian). Arch SocEspOftalmol80 (4): 255–8.
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