Dear Editor,
I read with a sense of déjà vu the original article on Association of central serous retinopathy (CSCR) with type of personality, anxiety and depression by Mukherji et al.[1] We have conducted a similar double-blind prospective trial in CSCR patients to diagnose any associated psychiatric illness by referring them to psychiatric OPD of our tertiary care hospital.[2]
The results in our series suggest that the CSCR patients (50 patients) were suffering from mixed anxiety spectrum (40%), adjustment disorder (34%), major depressive disorder (10%), and nil active psychiatric disorder (6%). These patients were started on a benzodiazepine-tab etizolam (0.5 mg) in the anxiety group or a combination of selective serotonin uptake inhibitors like escitalopram (5 mg) with clonazepam (0.5 mg) in the depression subset by the psychiatrist. This therapy acts by breaking the vicious cycle of anxiety disorder, leading to stress and release of corticosteroids and activation of catecholamines, which leads to hyper-permeability of choriocapillaris (pachychoroid) and retinal pigment epithelial degeneration and collection of CSCR fluid (exudative choroidopathy) at the macula. The resolution of CSCR is very rapid within 3–4 weeks, and the recurrences are reduced with this therapy.
The second part of the study was to evaluate the severity of CSCR with their DASS 21 (depression and anxiety stress scale, a questionnaire grading the levels of stress). This study was performed on 33 CSCR patients with controls, and psychiatric morbidity was significantly associated with the incidence (60.6%) and severity and chronicity of subretinal fluid in the CSCR group.
The importance of mental health is pivotal toward the well-being of an individual, and the association of CSCR with stress and depression is being discussed as one of the causes, along with the pachychoroid and choroidal venous overload. CSCR patients have a higher incidence of type A personality, and our study too showed a clear male preponderance in a white-collar job, a migrant population working in Mumbai metropolis under extreme stressful conditions.
As a corroboration to these findings, we can screen acute and chronic CSCR patients in OPD with appropriate anxiety and depression screening questionnaires. Patients found to have features of anxiety/depression are referred to psychiatrists for proper evaluation and treatment. We also counsel them on lifestyle modifications like yoga, meditation, and relaxation.[3]
Medical focal laser to leaks outside of the foveal avascular zone and micro pulse yellow laser to leaks closer to fovea is a definitive treatment of CSCR along with half fluence photodynamic therapy with visudyne (not available in India at present).
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Conflicts of interest
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References
- 1.Mukherji S, Karmarkar S, Dasgupta S. Association of central serous chorioretinopathy with type of personality, anxiety and depression. Indian J Ophthalmol. 2023;72:S60–5. doi: 10.4103/IJO.IJO_1180_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dudani AI, Hussein Ramakrishnan M, Telang O, Patil VM, Dudani K, Jadhav B, et al. Psychiatric evaluation in patients with central serous chorioretinopathy in Asian Indians. Indian J Ophthalmol. 2021;69:1204–7. doi: 10.4103/ijo.IJO_885_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Nongrem G, Surve A, Venkatesh P, Sagar R, Yadav RK, Chawla R, et al. Effect of short-term meditation training in central serous chorioretinopathy. Indian J Ophthalmol. 2021;69:3559–63. doi: 10.4103/ijo.IJO_3499_20. [DOI] [PMC free article] [PubMed] [Google Scholar]