Key Points
Question
What is the incidence of central serous chorioretinopathy (CSC) among patients who have ever used corticosteroid and those who have never used it, based on a national sample cohort in South Korea?
Findings
In this population-based cohort study, 5-year incidence of CSC per 10 000 person-years was 3.5 in the general population, 2.5 among those who had never used corticosteroids, and 3.6 among those who had ever used corticosteroids. The incidence was higher in men and those aged 40 to 49 years.
Meaning
These findings provide additional evidence that corticosteroid use increases the risk of CSC; however, the risk ratio in this study was less than that previously reported.
This study uses a national sample from South Korea to estimate the annual and 5-year incidence of central serous chorioretinopathy in the overall population and in those who have ever or never used corticosteroid medications.
Abstract
Importance
Information on the incidence of central serous chorioretinopathy (CSC) in individuals who receive corticosteroids is scarce but clinically important because these agents are useful and widely used.
Objective
To estimate the annual and 5-year incidence of CSC in South Korea in the overall population and in those who have used corticosteroid medications.
Design, Setting, and Participants
A cohort study of a population-based random sample included East Asian adults for whom records are held in the Korean National Health Insurance Service database for calendar years 2011 through 2015. The data analysis was performed from July 1, 2017 to January 5, 2018.
Exposures
Any type of corticosteroid use from 2002 through 2015.
Main Outcomes and Measures
Incidence of CSC.
Results
The data set contained data from 868 939 adults (4 117 768 person-years). From 2011 through 2015, 1423 individuals (among whom the mean [SD] age was 46.8 [16.4] years and 1091 [76.7%] were male) with newly diagnosed CSC were identified. From 2002 to 2015, 783 099 individuals in the data set (90.1%) had ever used corticosteroids. The incidence of CSC per 10 000 person-years was 3.5 (5.4 in men; 1.6 in women) among the total population, 2.5 (3.0 in men; 1.2 in women) in those who had never used corticosteroids, and 3.6 (5.7 in men; 1.6 in women) among those who had ever used corticosteroids. The risk of CSCR with individuals who had ever used corticosteroids was estimated as an adjusted hazard ratio of 1.81 (95% CI, 1.47-2.23) compared with those who have never used these drugs. Current or recent corticosteroid use showed a positive association with the incidence of CSC (depending on duration of use, adjusted hazard ratio ranged from 1.54 to 2.15). Corticosteroid use in 2006 through 2009 was associated with an increased incidence of CSC after 2011 (adjusted hazard ratio 1.57 [95% CI, 1.13-2.18]).
Conclusions and Relevance
In 2002 through 2015, 90.1% of adults in Korea received corticosteroids at least once. Although there was a clear difference in relative risk, this data analysis could not replicate the more than 30-fold increase in the risk ratio of CSC that has been reported previously. The incidence of CSC in the most vulnerable group, middle-aged men, was estimated to be approximately 1 case per 1000 corticosteroid users in the year following medication use. The overall incidence among those who had ever used corticosteroids and those who had never used these drugs was 2.5 and 3.6 per 10 000 person-years, respectively. This study provides additional evidence to support the potential role of corticosteroids in CSC.
Introduction
Central serous chorioretinopathy (CSC) is one of the most common vision-threatening retinopathies, after age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion.1 Many clinical studies have documented the characteristics of CSC in detail, including the higher incidence in men and the difference in incidence between elderly and middle-aged individuals.2 However, information on incidence is very scarce, with only 2 population-based studies reported to date. One study is from Olmsted County, Minnesota,3 and included only 74 cases, and the other is based on Taiwanese insurance data.4
The association of CSC with use of corticosteroids is well known. One case-control study revealed that use of corticosteroids increased the risk of CSC, with an odds ratio of 37.5 However, there is a lack of information on incidence, and the only published estimation of the incidence of CSC among persons taking corticosteroids (4.4 per 10 000 person-years) is based on Taiwanese insurance claims.6 Corticosteroids are used for long periods in some patients; therefore, we wanted to estimate the risk of CSC according to whether patients are past users, recent users, or long-term users of corticosteroids. Corticosteroids are useful agents, so information on the incidence of CSC among users of these medications would be clinically informative. The South Korean National Health Insurance Service (NHIS) is a good source of data on CSC in the general population as well as in corticosteroid users.
Methods
This nationwide cohort study was approved by the institutional review board of Severance Hospital, Yonsei University College of Medicine, and adhered to the tenets of the Declaration of Helsinki. The requirement for informed consent was waived in view of the retrospective design of the study and the deidentified nature of the data.
Database
The Korean NHIS initially developed a nationally representative sample of 1 million persons for research purposes in 2014. The NHIS–National Sample Cohort (NSC) 2002-20107 and an upgraded version using the same selected population and including a longer follow-up duration from 2002 to 20138 was released in 2015. In 2017, a second version, the NHIS-NSC 2002-2015, was released. A detailed cohort profile of the first version has already been published.9 Briefly, the NHIS covers more than 97% of the population of South Korea. A nationally representative sample of NHIS beneficiaries from all age groups (n = 1 000 000) was selected in 2006 for the second version, which includes all medical claims in this sample from 2002 to 2015. The strengths of the second version (the NHIS-NSC 2002-2015) include improved integrity and reliability because of data cleaning; a relatively long study duration, including 14 years of follow-up; improved representativeness using a more detailed 2142 sampling stratum (the product of categories defined by age [17 groups], sex [male and female], residential area [21 regions], and insurance type [3 types]); and a strengthened deidentification policy for concealing sensitive health information.
Participants and Central Serous Chorioretinopathy
The NHIS-NSC 2002-2015 provided data on each diagnostic code to 1 decimal place (eg, H35.7) in the period 2002 through 2010 and up to 2 decimal places (eg, H35.70) in 2011 through 2015. The most recent (seventh) edition of the Korean Classification of Diseases, which corresponds to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), was applied from January 2011, so the NHIS database has stored the information at a lower hierarchical level and with specific diagnostic codes since then. Therefore, in this database, only the H35.7 diagnostic code (which indicates “separation of retinal layers”) is available before January 2011, and the lower hierarchical and specific diagnostic code of H35.70 (which indicates “central serous chorioretinopathy”) is available after this date.
Incident cases of CSC are defined as patients who visited an ophthalmologist and received a diagnostic code of H35.70 (CSC) at least once.4 Patients who received a diagnostic code of H35.7 (separation of retinal layers) in 2002 through 2010 were not included in this study to exclude chronic or recurrent cases. Data were included in the study for individuals 20 years or older, who were enrolled in the NHIS between 2011 and 2015, and were followed up from January 1, 2011 (the index date), until the date of the first documentation of loss to follow-up because of disqualification by the NHIS (usually death) or until a diagnosis of CSC. The primary end point of the study was the incidence of CSC. For incidence estimates, the date of the earliest claim with the diagnostic code of CSC was defined as the event date.
Corticosteroid Exposure
Information on all types of corticosteroids used from 2002 through 2015 was identified, including formulation and route of administration, including topical application. To distinguish between past and recent or current use, the exposure period was divided into 3 groups (ie, corticosteroid use from 2002 through 2005, from 2006 through 2009, and from 2010 through 2015). These 3 groups were divided into 8 subgroups (Figure). More detailed information about the corticosteroid formulations and doses used is in the eMethods and eTables 1 to 4 in the Supplement.
Figure. Corticosteroid Use and Central Serous Chorioretinopathy.
CSC indicates central serous chorioretinopathy; HR, hazard ratio.
Statistical Analysis
The 5-year incidence of CSC per 10 000 person-years in adults 20 years and older was estimated by dividing the number of patients with a diagnosis of CSC by the total number of person-years of follow-up. A Cox proportional hazards model was used to calculate the adjusted hazard ratio (HR) with the 95% CI in the comparison between groups of corticosteroid users in the different study periods. The model was adjusted for age, sex, income level (10 strata), and residential area (16 regions). Prevalence was also estimated (eTable 5 in the Supplement). All P values were 2-sided, and those less than .05 were considered significant. The statistical analyses were performed using SAS version 9.4 (SAS Institute Inc) and Stata/MP version 14.0 (StataCorp).
Results
Incidence of CSC
Table 1 shows the annual incidence of CSC for the period of 2011 through 2015. In total, 1423 cases of CSC (in 1091 men and 332 women, with an overall mean [SD] age of 46.8 [16.4] years) were identified per 4 117 768 person-years. The incidence was 3.5 cases (95% CI, 3.3-3.6) per 10 000 person-years (5.4 for men and 1.6 for women). The ratio of cases in men to cases in women was 3.4.
Table 1. Annual Incidence of Central Serous Chorioretinopathy Per 10 000 Person-Years From 2011 Through 2015 (N = 868 939).
| Year | Men and Women | Men | Women | Ratio of Cases in Males to Cases in Females | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Person-Years | No. | Incidence (95% CI) | Person-Years | No. | Incidence (95% CI) | Person-Years | No. | Incidence (95% CI) | ||
| 2011 | 803 388 | 293 | 3.6 (3.3-4.1) | 396 924 | 220 | 5.5 (4.9-6.3) | 406 464 | 73 | 1.8 (1.4-2.3) | 3.1 |
| 2012 | 816 825 | 275 | 3.4 (3.0-3.8) | 403 715 | 213 | 5.3 (4.6-6.0) | 413 110 | 62 | 1.5 (1.2-1.9) | 3.5 |
| 2013 | 823 503 | 263 | 3.2 (2.8-3.6) | 407 154 | 215 | 5.3 (4.6-6.0) | 416 349 | 48 | 1.2 (0.9-1.5) | 4.4 |
| 2014 | 832 661 | 260 | 3.1 (2.8-3.5) | 412 015 | 205 | 5.0 (4.3-5.7) | 420 645 | 55 | 1.3 (1.0-1.7) | 3.8 |
| 2015 | 841 392 | 332 | 3.9 (3.5-4.4) | 416 531 | 238 | 5.7 (5.0-6.5) | 424 861 | 94 | 2.2 (1.8-2.7) | 2.6 |
| Total | 4 117 768 | 1423 | 3.5 (3.3-3.6) | 2 036 339 | 1091 | 5.4 (5.0-5.7) | 2 081 430 | 332 | 1.6 (1.4-1.8) | 3.4 |
Table 2 shows the incidence of CSC according to age group. The incidence was highest among the overall group aged 40 to 49 years (5.5 per 10 000 person-years) and in men aged 40 to 49 years (8.7 per 10 000 person-years). In women, the incidence was highest in the group aged 50 to 59 years (2.4 per 10 000 person-years). The ratio of cases in men to cases in women was 4.4 and 4.1 in those in the age groups 30 to 39 years and 40 to 49 years, respectively.
Table 2. Incidence of Central Serous Chorioretinopathy Per 10 000 Person-Years According to Age From 2011 Through 2015 (N = 868 939).
| Age Group | Men and Women | Men | Women | Ratio of Cases in Males to Cases in Females | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Person-Years | No. | Incidence (95% CI) | Person-Years | No. | Incidence (95% CI) | Person-Years | No. | Incidence (95% CI) | ||
| 20-29 | 688 766 | 37 | 0.5 (0.4-0.7) | 361 818 | 26 | 0.7 (0.5-1.1) | 326 948 | 11 | 0.3 (0.2-0.6) | 2.3 |
| 30-39 | 816 501 | 287 | 3.5 (3.1-3.9) | 417 326 | 236 | 5.7 (5.0-6.4) | 399 175 | 51 | 1.3 (1.0-1.7) | 4.4 |
| 40-49 | 900 436 | 491 | 5.5 (5.0-6.0) | 457 246 | 399 | 8.7 (7.9-9.6) | 443 190 | 92 | 2.1 (1.7-2.5) | 4.1 |
| 50-59 | 807 725 | 357 | 4.4 (4.0-4.9) | 404 741 | 262 | 6.5 (5.7-7.3) | 402 985 | 95 | 2.4 (1.9-2.9) | 2.7 |
| 60-69 | 465 166 | 162 | 3.5 (3.0-4.1) | 225 160 | 111 | 4.9 (4.1-5.9) | 240 006 | 51 | 2.1 (1.6-2.8) | 2.3 |
| 70+ | 439 175 | 89 | 2.0 (1.6-2.5) | 170 048 | 57 | 3.4 (2.6-4.3) | 269 126 | 32 | 1.2 (0.8-1.7) | 2.8 |
Incidence of CSC According to Corticosteroid Use
Table 3 shows the incidence of CSC in those who had ever used corticosteroids and those who had never used corticosteroids. Some form of corticosteroid therapy was documented to have been used at least once in 783 099 individuals in the total cohort of 868 939 individuals (90.1%) during the 14-year study period. In 2002 through 2015, 372 292 of 431 908 men (86.2%) and 410 807 of 437 031 women (94.0%) were identified to have ever used corticosteroids. The incidence of CSC was 3.6 per 10 000 person-years (5.7 in men vs 1.6 in women) among those who had ever used corticosteroids, and 2.5 per 10 000 person-years (3.0 in men vs 1.2 in women) among those who had never used corticosteroids. The incidence of CSC was lowest overall in women who did not use corticosteroids. The highest incidence was observed in male individuals aged 40 to 49 years who had ever used corticosteroids (9.4 per 10 000 person-years); the incidence in men of the same age without a history of corticosteroid use was almost half of that value (4.9 per 10 000 person-years).
Table 3. Incidence of Central Serous Chorioretinopathy Per 10 000 Person-Years From 2011 Through 2015 (N = 868 939).
| Age Group, y | Individuals Who Had Ever Used Corticosteroids (n = 783 099)a | Individuals Who Had Never Used Corticosteroids (n = 85 840)b | Ratio of Cases in Those Who Have Ever Used Corticosteroids to Cases in Those Who Have Never Used Corticosteroids | ||||
|---|---|---|---|---|---|---|---|
| Person-Years | No. | Incidence (95% CI) | Person-Years | No. | Incidence (95% CI) | ||
| Men (n = 431 908) | 1 755 257 | 1006 | 5.7 (5.4-6.1) | 281 082 | 85 | 3.0 (2.4-3.7) | 1.9 |
| 20-29 | 314 650 | 25 | 0.8 (0.5-1.2) | 47 168 | 1 | 0.2 (0.0-1.5) | 4.0 |
| 30-39 | 349 827 | 206 | 5.9 (5.1-6.8) | 67 499 | 30 | 4.4 (3.1-6.4) | 1.3 |
| 40-49 | 384 461 | 363 | 9.4 (8.5-10.5) | 72 785 | 36 | 4.9 (3.6-6.9) | 1.9 |
| 50-59 | 347 506 | 249 | 7.2 (6.3-8.1) | 57 234 | 13 | 2.3 (1.3-3.9) | 3.1 |
| 60-69 | 201 813 | 107 | 5.3 (4.4-6.4) | 23 347 | 4 | 1.7 (0.6-4.6) | 3.1 |
| ≥70 | 156 999 | 56 | 3.6 (2.7-4.6) | 13 049 | 1 | 0.8 (0.1-5.4) | 4.5 |
| Women (n = 437 031) | 1 960 429 | 318 | 1.6 (1.5-1.8) | 121 001 | 14 | 1.2 (0.7-2.0) | 1.3 |
| 20-29 | 308 374 | 10 | 0.3 (0.2-0.6) | 18 575 | 1 | 0.5 (0.1-3.8) | 0.6 |
| 30-39 | 378 655 | 48 | 1.3 (1.0-1.7) | 20 520 | 3 | 1.5 (0.5-4.5) | 0.9 |
| 40-49 | 414 205 | 90 | 2.2 (1.8-2.7) | 28 985 | 2 | 0.7 (0.2-2.8) | 3.1 |
| 50-59 | 378 001 | 92 | 2.4 (2.0-3.0) | 24 984 | 3 | 1.2 (0.4-3.7) | 2.0 |
| 60-69 | 227 730 | 47 | 2.1 (1.6-2.7) | 12 276 | 4 | 3.3 (1.2-8.7) | 0.6 |
| ≥70 | 253 466 | 31 | 1.2 (0.9-1.7) | 15 661 | 1 | 0.6 (0.1-4.5) | 2.0 |
| Total (n = 868 939) | 3 715 685 | 1324 | 3.6 (3.4-3.8) | 402 083 | 99 | 2.5 (2.0-4.3) | 1.4 |
This group includes 372 292 men and 410 807 women.
This group includes 59 616 men and 26 224 women.
The Figure shows the incident cases of CSC according to corticosteroid exposure in the periods 2002 through 2005, 2006 through 2009, and 2010 through 2015. The proportion was highest in individuals who used corticosteroids during all 3 study periods (n = 325 317 [37.4%]). The proportion was 13% in former corticosteroid users (4.6% in 2002 through 2009, 4.1% in 2006 through 2009, and 4.6% in 2002 through 2005). The risk of CSC was higher in those who had ever used corticosteroids than in those who had never used corticosteroids (adjusted HR, 1.81 [95% CI, 1.47-2.23]). Individuals who had recently used corticosteroids (in 2010-2015), including those who had also used these agents in 2002 through 2005 or 2006 through 2009, were more likely to have CSC than those who had never used corticosteroids (depending on the period, the adjusted HR ranged from 1.54 [95% CI, 1.20-1.91] to 2.15 [95% CI, 1.73-2.67]). Users with exposure to corticosteroids in all 3 periods had the strongest association with a risk of CSC (HR, 2.15 [95% CI, 1.73-2.67]). There was no association of the 2 subgroups of former users, but a positive association remained for 1 subgroup of former users; in other words, there was a positive association of corticosteroid use in 2006 through 2009 with incident CSC (adjusted HR, 1.57 [95% CI, 1.13-2.18]). No association was observed in the corticosteroid-exposed groups in 2002 through 2009 (adjusted HR, 0.98 [95% CI, 0.66-1.45]) or in the former corticosteroid-exposed groups in 2002 through 2005 (adjusted HR, 1.18 [95% CI, 0.83-1.68]). Other explorative analyses of the dosage form and doses taken are described in eTable 1 and eTable 2 in the Supplement.
Prevalence
The prevalence data are summarized in eTable 5 in the Supplement. The prevalence in 2011 through 2015 was 6.1 per 10 000 persons (9.4 in men vs 3.0 in women). The annual prevalence per 10 000 persons gradually increased from 5.5 in 2011 to 7.3 in 2015.
Discussion
The present study estimates that the population-based incidence of CSC is 3.5 per 10 000 person-years in the general Korean population (5.4 in men vs 1.6 in women). Surprisingly, more than 90% of adults had been prescribed some form of corticosteroid therapy in the 14 years from 2002 through 2015. The incidence of CSC was lower in adults who had never used corticosteroids (2.5 per 10 000 person-years) and higher in those who had ever used corticosteroids (3.6 per 10 000 person-years). This estimated difference in the incidence rate had an adjusted HR of 1.81 (95% CI, 1.47-2.23).
Two other studies have focused on the incidence of CSC using a population-based sample. The study based on a medical record review of patients in Olmsted County from 1980 to 2002 reported an annual incidence of 1.0 (95% CI, 0.7-1.2) in 10 000 men and 0.2 (95% CI, 0.1-0.3) in 10 000 women, giving a total of 74 cases of CSC.3 This figure is lower than that in our study, which may reflect the fact that the Olmsted County study included a predominantly white population, whereas the sample in this study was Korean. That study failed to show the association of CSC with corticosteroid use; however, as noted by the authors in the limitation section of their report, 74 cases of CSC is too small to constitute a representative sample. The other study was based on Taiwanese insurance data from 2001 to 2006 and reported an annual incidence of CSC of 2.1 per 10 000 adults aged 20 to 64 years with no history of corticosteroid use (2.7 per 10 000 men vs 1.5 per 10 000 women).4 In the present study, the incidence was 2.5 per 10 000 person-years in those who had never used corticosteroids (3.0 in men vs 1.2 in women; Table 3). The slightly higher incidence of CSC in South Korea may reflect better access to medical care and more use of corticosteroids in this country; alternatively, it may simply reflect an actual increase in incidence over the past decade. Consistent with the Taiwanese report, CSC occurred most frequently in male individuals aged 35 to 39 years who had ever used corticosteroids, with a peak incidence of 4.9 per 10 000 person-years in the Korean study and 4.4 per 10 000 person-years in the Taiwanese study.4
The association between CSC and corticosteroid exposure has been widely reported in the literature.6,10,11,12,13,14,15,16,17 Of 412 035 users of oral corticosteroids who were followed up from 2000 to 2008 in the Taiwan study, 320 cases of CSC were documented, and the incidence rate was 4.4 per 10 000 person-years (5.5 in men and 3.4 in women).6 In the present study, the incidence rate of CSC was 3.6 per 10 000 person-years in corticosteroid users overall (5.7 in men and 1.6 in women; Table 3). In the Taiwanese study, corticosteroid use was defined as an oral corticosteroid having been prescribed at least twice in 2 consecutive months, whereas in the present study, the status of having ever used corticosteroids was defined as use of any type of corticosteroid by any route in 2002 through 2015. Therefore, the lower incidence of CSC in our study may reflect a less stringent definition of corticosteroid use (including, for example, one-time use of a topical corticosteroid cream) than that in the Taiwanese study.6 One retrospective, multicenter case-control study that reported on 312 patients with CSC (including 45 in patients who had used corticosteroids) and 312 control participants (selected patients with differing ophthalmologic conditions, including 5 corticosteroid users) estimated the risk of CSC associated with corticosteroid use, and ultimately reported an odds ratio of 37.1 (95% CI, 6.2-221.8)5; however, this wide CI implies an insufficient number of cases in their analysis. The researchers performing the aforementioned study acknowledged the major limitation of using a retrospective approach, because physicians evaluating patients with CSC are more likely to ask about corticosteroid use because of its well-known association with this health condition. The incidence of CSC among corticosteroid users in South Korea and Taiwan suggests that the figure reported in that study is an overestimate.
Our findings showed that the prior use of corticosteroids also significantly increased the risk of the future development of CSC (Figure). However, we believed it was necessary to critically analyze this interpretation because of the relatively few cases of CSC reported among former users; there were 35, 58, and 46 CSC cases among individuals in the corticosteroid-exposed groups in 2002 through 2009, 2006 through 2009, and 2002 through 2005, respectively. There was no significant increase in the risk of the incidence of CSC in the 2002 through 2009 corticosteroid-exposed group; however, those using corticosteroids between 2006 and 2009 were at a significantly increased risk. We did not appreciate any particular differences in the baseline characteristics of the 2 groups in our explorative analysis. Additional observational studies are needed to determine whether a more recent history of corticosteroid use increases the risk of CSC.
Limitations
Several limitations should be taken into consideration when interpreting the results of this study. Diagnoses based on the Korean Standard Classification of Diseases may be less accurate than those obtained using some of the other standardized procedures. Misclassification is also possible. However, cross-sectional epidemiologic studies of CSC would be very difficult to perform because of the transient nature of the disease and the inability to identify it after recovery.
Studies based on medical record review as well as claims data suffer from the possibility of underestimation. A claims-based study may not be the most accurate way of investigating the incidence of this episodic disease but may still provide a reasonable estimation of the association of CSC with the use of corticosteroids. A more accurate analysis of the various routes of administration and formulations of corticosteroids used is needed. However, as mentioned in the eMethods in the Supplement, it is difficult to analyze the use of corticosteroids prospectively because of the real-world complexities involved.
It would also be ideal to evaluate the association with various other diseases; however, this goes beyond the scope of this study. Lastly, the limitations of this study include the possibility that ethnic differences may exist among individuals of non–South Korean ethnic groups.
Conclusions
This retrospective population-based cohort study investigated the incidence of CSC in the South Korean population and found an incidence of 3.5 cases per 10 000 person-years in the total population, with rates of 2.5 per 10 000 person-years in those who had never used corticosteroids and 3.6 per 10 000 person-years in those who had ever used corticosteroids. Use of corticosteroids was clearly associated with an increased risk of CSC; the likelihood of developing CSC was affected not only by recent use but also by earlier use (although future observational studies are required to determine a potential increased recency effect, by which a more recent history of corticosteroid use carries a greater risk than more remote exposure to corticosteroids). When 10 000 people were followed up for 1 year, CSC was diagnosed in as many as 4 patients who had used corticosteroids (3.6 [95% CI, 3.4-3.8]) and in as many as 3 who had not (2.5 [95% CI, 3.0-3.0]). The most vulnerable group was men aged 40 to 49 years, in whom the incidence of CSC was approximately 5 per 10 000 person-years among those who had never used corticosteroids and up to 10 (ie, approximately 1 per 1000 person-years) in those who had ever used corticosteroids. In women, the incidence of CSC per 10 000 person-years was 1.2 among those who had never used corticosteroids and 1.6 among those who had ever corticosteroids, with the risk increasing to up to 3 per 10 000 person-years in female corticosteroid users aged 50 to 59 years. It is important to be able to provide patients with accurate information about the adverse effects of corticosteroids.
Overall, approximately 4 new cases per year of CSC per 10 000 people who had ever used corticosteroid is considerably less than the risk ratio previously reported. Corticosteroids are widely used, so it is clinically helpful to have an appreciation of the incidence of CSC in patients taking these agents.
eMethods. Steroid Exposure and Central Serous Chorioretinopathy
eTable 1. Steroid use between 2002 and 2010 and Central Serous Chorioretinopathy.
eTable 2. Incidence of central serous chorioretinopathy according to amount of oral steroid exposure (n=394,788)
eTable 3. Medical departments responsible for the prescription of corticosteroids in 2002
eTable 4. Thirty most frequent diagnoses associated with the prescription of corticosteroids in 2002
eTable 5. Prevalence of central serous chorioretinopathy per 10,000 individuals during 2011–2015 in South Korea
References
- 1.Wang M, Munch IC, Hasler PW, Prünte C, Larsen M. Central serous chorioretinopathy. Acta Ophthalmol. 2008;86(2):126-145. doi: 10.1111/j.1600-0420.2007.00889.x [DOI] [PubMed] [Google Scholar]
- 2.Daruich A, Matet A, Dirani A, et al. . Central serous chorioretinopathy: recent findings and new physiopathology hypothesis. Prog Retin Eye Res. 2015;48:82-118. doi: 10.1016/j.preteyeres.2015.05.003 [DOI] [PubMed] [Google Scholar]
- 3.Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002. Ophthalmology. 2008;115(1):169-173. doi: 10.1016/j.ophtha.2007.02.032 [DOI] [PubMed] [Google Scholar]
- 4.Tsai DC, Chen SJ, Huang CC, et al. . Epidemiology of idiopathic central serous chorioretinopathy in Taiwan, 2001-2006: a population-based study. PLoS One. 2013;8(6):e66858. doi: 10.1371/journal.pone.0066858 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Haimovici R, Koh S, Gagnon DR, Lehrfeld T, Wellik S; Central Serous Chorioretinopathy Case-Control Study Group . Risk factors for central serous chorioretinopathy: a case-control study. Ophthalmology. 2004;111(2):244-249. doi: 10.1016/j.ophtha.2003.09.024 [DOI] [PubMed] [Google Scholar]
- 6.Tsai DC, Chen SJ, Huang CC, et al. . Risk of central serous chorioretinopathy in adults prescribed oral corticosteroids: a population-based study in Taiwan. Retina. 2014;34(9):1867-1874. doi: 10.1097/IAE.0000000000000159 [DOI] [PubMed] [Google Scholar]
- 7.Rim TH, Kim DW, Han JS, Chung EJ. Retinal vein occlusion and the risk of stroke development: a 9-year nationwide population-based study. Ophthalmology. 2015;122(6):1187-1194. doi: 10.1016/j.ophtha.2015.01.020 [DOI] [PubMed] [Google Scholar]
- 8.Rim TH, Han J, Choi YS, et al. . Retinal artery occlusion and the risk of stroke development: twelve-year nationwide cohort study. Stroke. 2016;47(2):376-382. doi: 10.1161/STROKEAHA.115.010828 [DOI] [PubMed] [Google Scholar]
- 9.Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2017;46(2):e15. [DOI] [PubMed] [Google Scholar]
- 10.Chang YS, Weng SF, Chang C, Wang JJ, Wang JY, Jan RL. Associations between topical ophthalmic corticosteroids and central serous chorioretinopathy: a Taiwanese population-based study. Invest Ophthalmol Vis Sci. 2015;56(6):4083-4089. doi: 10.1167/iovs.14-16360 [DOI] [PubMed] [Google Scholar]
- 11.Carvalho-Recchia CA, Yannuzzi LA, Negrão S, et al. . Corticosteroids and central serous chorioretinopathy. Ophthalmology. 2002;109(10):1834-1837. doi: 10.1016/S0161-6420(02)01117-X [DOI] [PubMed] [Google Scholar]
- 12.Haimovici R, Gragoudas ES, Duker JS, Sjaarda RN, Eliott D. Central serous chorioretinopathy associated with inhaled or intranasal corticosteroids. Ophthalmology. 1997;104(10):1653-1660. doi: 10.1016/S0161-6420(97)30082-7 [DOI] [PubMed] [Google Scholar]
- 13.Jampol LM, Weinreb R, Yannuzzi L. Involvement of corticosteroids and catecholamines in the pathogenesis of central serous chorioretinopathy: a rationale for new treatment strategies. Ophthalmology. 2002;109(10):1765-1766. doi: 10.1016/S0161-6420(02)01303-9 [DOI] [PubMed] [Google Scholar]
- 14.Sharma T, Shah N, Rao M, et al. . Visual outcome after discontinuation of corticosteroids in atypical severe central serous chorioretinopathy. Ophthalmology. 2004;111(9):1708-1714. doi: 10.1016/j.ophtha.2004.03.025 [DOI] [PubMed] [Google Scholar]
- 15.Fernandez CF, Mendoza AJ, Arevalo JF. Central serous chorioretinopathy associated with topical dermal corticosteroids. Retina. 2004;24(3):471-474. doi: 10.1097/00006982-200406000-00027 [DOI] [PubMed] [Google Scholar]
- 16.Ishida Y, Kato T, Minamoto A, Yokoyama T, Jian K, Mishima HK. Retinal pigment epithelial tear in a patient with central serous chorioretinopathy treated with corticosteroids. Retina. 2004;24(4):633-636. doi: 10.1097/00006982-200408000-00028 [DOI] [PubMed] [Google Scholar]
- 17.Tittl MK, Spaide RF, Wong D, et al. . Systemic findings associated with central serous chorioretinopathy. Am J Ophthalmol. 1999;128(1):63-68. doi: 10.1016/S0002-9394(99)00075-6 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eMethods. Steroid Exposure and Central Serous Chorioretinopathy
eTable 1. Steroid use between 2002 and 2010 and Central Serous Chorioretinopathy.
eTable 2. Incidence of central serous chorioretinopathy according to amount of oral steroid exposure (n=394,788)
eTable 3. Medical departments responsible for the prescription of corticosteroids in 2002
eTable 4. Thirty most frequent diagnoses associated with the prescription of corticosteroids in 2002
eTable 5. Prevalence of central serous chorioretinopathy per 10,000 individuals during 2011–2015 in South Korea