Central serous retinopathy (CSR), or central serous chorioretinopathy (CSC), is an eye disease that causes visual impairment. The condition is often temporary, usually affecting only one eye.It primarily affects males between 20-50 years of age, but may also occur in women.1-2 The principal 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 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 and CSR
CSR has been associated with the use of cortisol and corticosteroids (e.g., prednisone). Patients presenting with CSR often have higher blood levels of cortisol.3 Cortisol is a hormone secreted 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, which are commonly used to treat inflammatory conditions, allergies, skin conditions such as eczema, and even certain eye conditions, can trigger, aggravate and/or cause a relapse of CSR.4-6 A study published in Archives of Ophthalmology showed that of 60 individuals with Cushing's syndrome, a condition characterized by high cortisone levels, CSR was present in 5 percent of the patients.7
Nutritional 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 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 effects8-18
Some anecdotal evidence suggests supplementation with the carotenoids lutein and zeaxanthin also 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 multivitamin / mineral containing vitamin C – 1,000 mg, vitamin E – 400 IU, selenium – 200 mcg, beta-carotene – 15,000 IU, and 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
- Wang M, Munch IC, Hasler PW, Prünte C, Larsen M. Central serous chorioretinopathy. Acta Ophthalmologica, 2008;86(2):126-45.
- Quillen DA, Gass JDM, Brod RD, Gardner TW, et al. Central serous chorioretinopathy in women. Ophthalmology, 1996;103(1):72-79.
- Garg SP, Dada T, Talwar D, Biswas NR. Endogenous cortisol profile in patients with central serous chorioretinopathy. Br J Ophthalmol, November 1997;81(11):962-4.
- Pizzimenti JJ, Daniel KP. Central serous chorioretinopathy after epidural steroid injection. Pharmacotherapy, 2005;25(8):1141-6.
- Bevis T, Ratnakaram R, Smith MF, Bhatti MT. Visual loss due to central serous chorioretinopathy during corticosteroid treatment for giant cell arteritis. Clin Exper Ophthalmol, 2005;33(4):437-9.
- Fernández Hortelano A, Sádaba LM, Heras Mulero H, García Layana A. [Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids] (in Spanish; Castilian). Arch Soc Esp Oftalmol, 2005;80(4):255-8.
- Bouzas EA, Scott MH, Mastorakos G, Chrousos GP, Kaiser-Kupfer MI. Central serous chorioretinopathy in endogenous hypercortisolism. Arch Ophthalmol, September 1993;111;(9):1229-33.
- Yadav CS, Kumar V, Suke RS, et al. Propoxur-induced actetylcholine esterase inhibition and impairment of cognitive function: attenuation by Withania somnifera (Ashwagandha). Indian Jrnl Biochem & Biophys, 2010;47:117-120.
- Mishra LC, Singh BS, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (Ashwagandha): a review. Alt Med Rev, 2000;5(4):334-346.
- Mirjalili MH, Moyano E, Bonfill M, et al. Steroidal lactones from Withania somnifera (Ashwagandha), an ancient plant for novel medicine. Molecules, 2009;14:2373-2393.
- Kulkarni SK, Dhir A. Withania somnifera: an Indian ginseng. Prog Neuro-Psychopharm & Biol Psych, 2008;32:1093-1105.
- Panossian A, Wilkman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol, 2009;4(3):198-219.
- Aslanyan G, Amroyan E, Gabrielyan E et al. Double-blind, placebo-controlled, randomised study of single dose effects of ADAPT-232 (Rodiola ,Schidandra and Eleutherococcus extract) on cognitive functions. Phytomed, 2010;7(7):494-499.
- Spasov AA, Wikman GK, Madrikov VB et al. A double-blind, placebo-controlled pilot study of the stimulating effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with repeated low-dose regim. Phytomed, 2000;7(2):85-89.
- Khanum F, Bawa AS, Singh B. Rhodiola rosea: a versatile adaptogen. Comp Rev Food Sci Food Saf, 2005;4:55-62.
- Guo LY, Hung TM, Bae KH, et al. Anti-inflammatory effects of schisandrin isolated from the fruit of Schisandra chinesis Baill. Europ Jrnl Pharmacol, 2008;591:293-299.
- Cheng H, Hsieh M, Wu C et al. Schizandrin protects primary cultures of rat cortical cells from glutamate-induced excitotoxicitiy. J Pharmacol Sci, 2008;107:21-31.
- Panossian A, Wikman G. Pharmacology of Schisandra chinensis bail: an overview of Russian research and uses in medicine. Jrnl Ethnopharmacol;118(2):183-212.
- Jampol LM, et al. Age-Related Eye Disease Study Research Group (collective name-AREDS). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta-carotene, and zinc for age-related macular degeneration and vision loss: AREDS Report No. 8. Arch Ophthalmol, October2001;119(10):1417-36.
- Dagnelie G, et al. Lutein improves visual function in some patients with retinal degeneration: a pilot study via the Internet. Optometry, 2000,71;3:147-164.
- Seddon JM, et al. Dietary carotenoids, vitamin A, C, and E and advanced age-related macular degeneration. JAMA, 1994;272:1413-1420.
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