Comments and Conclusions (Cont’d)
• Acute CSC has been significantly associated with stress and Type A personality. In a study of 33 patients with acute CSC, 91% had experienced a “very disturbing” psychological event prior to the disturbed vision (such is the case in our first patient) and were “tension ridden”.8,9
• It has been hypothesized that raised circulating adrenergic agents could act on alpha-1 and beta receptors to cause leakage of choroldal vessels, leading to CSC. Similar conditions have been seen in animals after an i.v. injection of adrenaline.10
• In the first case, it appears that the fovea was never involved and hence the vision was and remains normal.
• The PIL is intact under the fovea and predicts the normal VA in the first case; PIL disruption outside the fovea results in changes that are often detectable with the Amsler grid.
• The stress related event vividly recalled by the first patient 13 years earlier was likely the trigger for the bilateral CSC.
• PatIents with old CSC should be monitored carefully since they are at a higher risk of developing both wet and dry AMD at an earlier age. (see RR case 3)
• Patients with previous stress induced CSC appear to have a greater risk of another episode with new stress and hence should be monitored closely.