Retinopathia centralis serosa is often referred to as “manager’s disease” by ophthalmologists. The reason is that a lot of stress can trigger this vision disorder. In this case, a gray spot appears in the visual field, objects are seen distorted, and reading and recognizing colors are difficult.
What is retinopathy centralis serosa?
Retinopathia centralis serosa is a disease of the retina. In this condition, fluid leaks from the choroid, causing localized detachment of the retina from the pigment epithelial layer. This is called swelling-induced detachment of the retina. It is pushed forward and closer toward the lens. The unevenness that results lifts the photoreceptors out of their conventional position. In rare cases, the retina and retinal pigment epithelium detach together if the pigment layer is intact. The disease predominantly affects men between the ages of 20 and 50, but it also occurs in women. The onset is often associated with physical or mental stress.
Causes
The exact cause of retinopathia centralis serosa, the retinal change, is not known. However, stress has been very commonly cited as a trigger for the condition for many years. Studies have shown that those affected often show a pronounced competitive behavior, have a lot to organize and manage, and are agile. This is also the reason for the used name “manager’s disease”. However, this does not mean that every stressed person develops the eye disease. The reason is a different processing of stress. The disease can also be associated with an increased concentration of the stress hormone cortisol. Experts suspect that a genetic susceptibility may also favor the occurrence of retinopathia centralis serosa. The same applies to an infection with Helicobacter pylori, a stomach germ. In this association, too, the eye disease has been observed to some extent. Ultimately, the clinical picture of retinopathia centralis serosa has not yet been sufficiently researched.
Symptoms, complaints, and signs
In retinopathia centralis serosa, a gray-black hole appears in the field of vision. Vision becomes clouded by a gray haze, and objects appear distorted or double. These are all typical symptoms of the eye disease, which often appears rather suddenly. In addition, due to the detachment of the retina from the choroid, there is often unilateral or bilateral farsightedness. Another sign of retinopathy centralis serosa is wave vision. Equally typical is the loss in the central visual field. This results in gray, black, or blurry vision in a spot in the center of the visual field.
Diagnosis and course of the disease
When retinopathy centralis serosa is suspected, a history and careful examination by an ophthalmologist are necessary. This is because the changes in vision may result from other conditions that present with similar symptoms. The doctor has various options available for accurate diagnosis, for example, an eye test. This usually involves hyperopia of the affected eye. Also possible is apparative perimetry, for example threshold perimetry, which serves to determine and quantify the scotoma. Funduscopy ophthalmoscopically shows a visible edematous swelling of the retina. Color vision testing and spectral optical coherence tomography|spectral optical coherence tomography (SOCT) are also used. Here, the detachment of the retina can be directly visualized, because this imaging technique produces a cross-sectional image. There are acute and chronic forms of retinopathy centralis serosa, which can occur unilaterally or bilaterally. In the acute form, the disease usually heals spontaneously within three to six months of onset. Therefore, it is common to initiate therapy only after three months. Significant vision loss remains only in isolated cases, but one or more recurrences of the disease may occur. If retinopathia centralis serosa occurs repeatedly and leaves changes, it is called a chronic form. In this case, treatment should be started sooner.
Complications
Retinopathy centralis serosa is rarely associated with complications.As a rule, spontaneous healing takes place. However, the disease itself occurs as a complication of a stress reaction in highly stressed individuals. Because it often afflicts leaders, it is commonly referred to as manager’s disease. Although the retina partially detaches from the choroid due to the invading fluid, blindness almost never occurs. After several weeks or months, the disease heals without treatment and vision returns to normal. Sometimes, however, more severe courses occur. Then a therapy should be considered. In photothermal therapy, the retina is treated with heat. However, if the swelling is outside the macula, laser treatment should be used in severe courses, since photothermal therapy leads to destruction of the retina due to the heat generated in this case. After the symptoms have subsided, recurrences occur in some patients. To avoid such recurrences, smoking and taking cortisone-containing medications should be avoided. Reducing stress also promotes complete healing. Mostly, ambitious and impatient young men are affected, but they are so disturbed by the sudden visual disturbance that they may also need psychological support. In the context of psychotherapy, it can be discussed how stress reduction can be achieved in the specific case.
When should one go to the doctor?
Retinopathy centralis serosa should always be treated by a physician. There is no self-healing with this disease. If left untreated, the disease can lead to severe limitations and discomfort in everyday life. A doctor should be consulted if the patient suffers from a disturbed field of vision. This can lead to the appearance of a black or gray spot in the field of vision, so that the affected person can no longer recognize objects correctly. Furthermore, sudden farsightedness is also indicative of retinopathy centralis serosa and must be investigated if it occurs without a specific reason and relatively suddenly. Similarly, the visual field may be accompanied by deficits, so that the affected person also suffers from disturbances in sensibility. Many patients are also unable to recognize colors properly due to retinopathia centralis serosa. If these complaints occur, an ophthalmologist can be consulted. Usually, retinopathia centralis serosa can be treated well if it is detected early.
Treatment and therapy
In most cases, no therapy is needed for retinopathia centralis serosa, as the disease usually resolves on its own. Affected individuals often recover from the visual disturbances within the next few months. Patience is all that is required. In case of a severe course or repeated relapses, treatment should be initiated. In these cases, laser treatment can be considered, which is very often used for this eye condition. The leaking area, which is located in the choroid, is sclerosed with the laser. However, the prerequisite for this is that there is an eccentric position with regard to the source point. If everything goes well, the retina adheres to its base again due to the laser light. Slight scarring may occur, but this is not problematic. In some patients, however, repeated detachment of the retina results in extensive scarring, so that vision is noticeably impaired. Even in the case of spontaneous healing, slight limitations of vision or quality of vision sometimes remain. Another procedure to treat retinopathia centralis serosa is photodynamic therapy. In this procedure, a light-sensitive drug is injected into the vein in the arm and spreads throughout the body within the next 15 minutes, which includes the vessels of the choroid. The drug is specifically activated by laser irradiation and the leaking blood vessel is sealed.
Prevention
To prevent the occurrence of retinopathia centralis serosa, stress levels should be cut back. Relaxation techniques such as qigong and autogenic training are also helpful. This contributes to balance and an optimal work-life balance. It is always important to be aware of how stress affects the body.Exercise is also helpful, because movement strengthens the immune system and promotes the breakdown of stress hormones suspected of triggering retinopathia centralis serosa.
Follow-up
Unlike similar eye diseases, retinopathy does not lead to complete blindness. Even without ophthalmologic therapy, retinopathia centralis serosa can heal on its own. If symptoms persist, specific treatment should be considered. Symptoms may persist for several weeks or months. A visit to the ophthalmologist is nevertheless advisable; in the course of follow-up care, the condition should be maintained after therapy. The medium to long-term goal is to avoid a relapse, the patient should live permanently free of symptoms. Treatment options include surgery or medication. The progress of healing is monitored during follow-up care. If an eye operation has been performed, the well-known postoperative follow-up takes effect. It ends with the discharge from the clinic. If the desired effect could be achieved with appropriate medicine, the specialist stops the therapy and starts the aftercare. The condition of the eyes is checked at regular intervals even after surgery. If the symptoms return, the treatment starts again. The patient can also do his or her part in the aftercare by eating a healthy diet and attending the check-up appointments. On the other hand, patients should refrain from excessive alcohol and nicotine consumption. Complete abstention from these stimulants would be ideal.
What you can do yourself
Retinopathia centralis serosa often develops in connection with a stressful workday. That’s why it’s helpful for sufferers to lower their stress levels. Physical relaxation and also mental exercises such as meditation can help reduce vision problems. In any case, it is important to consult an ophthalmologist quickly if problems arise. After the examination and the therapy recommendations, those affected can do something themselves to make everyday life easier. Resting not only protects the eyes, but the entire organism. Through proper relaxation, the symptoms usually disappear again without medication. However, the doctor may also suggest a special therapy approach. This depends on the severity of the disease and the patient’s individual situation. In addition to a healthy lifestyle with nutritious food and enough exercise, it helps to reduce stress and avoid stimulants such as nicotine and alcohol. Medications containing cortisone are also considered to trigger the eye disease. In consultation with the doctor, it should be considered whether it makes sense to discontinue certain medications for chronic diseases. This could support self-healing, although other complaints that may be present must also be taken into account.
