Association of Central Serous Chorioretinopathy with Psychosocial Factors is Dependent on Its Phase and Subtype

Abstract

Purpose: To analyze the psychosocial factors associated with central serous chorioretinopathy (CSC) according to its phases and subtypes and to correlate the factors with the extent of choroidal hyperpermeability.

Methods: Age- and sex-matched CSC patients and controls (n = 37 in each group) were enrolled, and their psychosocial factors were compared. CSC was divided into two phases (active and inactive), and active CSC was further divided into two subtypes (acute and chronic). The correlations between the size of the hyperpermeable choroidal lesion identified on indocyanine green angiography and psychosocial factors were examined.

Results: Active CSC patients experienced more stressful events (p = 0.030), were more depressive (p = 0.037), and felt less emotional (p = 0.014) and informational (p = 0.014) support than the matched controls, whereas inactive CSC patients were comparable to the matched controls in all psychosocial factors. Among the active CSC patients, acute patients were more depressive (p = 0.029), while chronic patients experienced more stressful events (p = 0.024) than their matched controls. The size of the hyperpermeable choroidal lesion was correlated with the severity of depression in acute patients.

Conclusions: Association of CSC with psychosocial factors was dependent on the phase and subtype of CSC. Psychosocial factors were associated with CSC in the active phase, and severity of depression was correlated with the size of the choroidal pathology in acute active CSC. Further prospective studies to investigate if psychosocial factors can trigger CSC are warranted.

Keywords: Anxiety; Central serous chorioretinopathy; Choroid; Depression; Psychological stress.

Fig. 1. Measurement of hyperpermeable choroidal lesion size. We measured the diameter of the smallest circle (dotted circles) that covered the main hyperpermeable choroidal lesions identified on mid-to late-phase indocyanine green angiography. (A) The white dotted circle covers the central main lesion. (B) The dotted circle covers all separated hyperpermeable lesions.

Fig. 2. Correlations between hyperpermeable choroidal lesion size and psychometric parameters in acute (A, state anxiety; B, trait anxiety; C, stress; D, depression) and chronic (E, state anxiety; F, trait anxiety; G, stress; H, depression) central serous chorioretinopathy (CSC) patients. (D) Depression scores showed significant correlation with the size of the hyperpermeable choroidal lesion in acute CSC. (E,F) State anxiety scores and trait anxiety scores showed borderline significant correlation with the size of the hyperpermeable choroidal lesion in chronic CSC.