Asian patients with central serous chorioretinopathy at increased risk for exudative AMD
Adults with central serous chorioretinopathy are at higher risk for exudative age-related macular degeneration, particularly in Asian populations, according to a nationwide cohort study conducted in South Korea.
“The present study was performed as a result of the uncertainty regarding the association between [central serous chorioretinopathy] and AMD in Asian populations,” with evidence supporting a possible link between the two in this population, Ju-Yeun Lee, MD, and Kunho Bae, MD, of Seoul National University Hospital in South Korea, wrote in Retina.
In a retrospective study, researchers examined Korean Health Insurance Review and Assessment Service (HIRA) claims data from January 2013 to December 2019 to determine the risk of AMD in patients who were diagnosed with central serous chorioretinopathy (CSC).
“A recent HIRA publication reported that approximately 1% of the total population covered by health insurance comprises foreign nationals,” Lee and Bae wrote. “We assumed that most of the people included in the study were Asian, although further analysis is needed to verify this assumption.”
Any patient with CSC during the study period who was continuously enrolled in a medical plan for 6 months or longer was included in the cohort.
Researchers examined records of 11,492 patients with CSC — 8,946 men and 2,546 women — ranging in age from 30 to 79 years (mean age, 49 years). Those patients were matched by age and sex with a non-CSC group made up of 17,892 men and 5,092 women.
Using a stratified log-rank test to compare the incidence rates of AMD between the CSC and non-CSC groups, researchers found that the rate of incidental AMD was 1.44% in those with CSC and that their risk for exudative AMD was 4.86 times higher than the risk for those who did not have CSC. Researchers also reported that those who developed CSC at an older age were at even greater risk than those diagnosed with CSC at a younger age.
“Although CSC is a self-limiting disorder, the incidence of exudative AMD increases with age after 60 years,” Lee and Bae wrote. “Thus, more frequent screening examinations and self-screening using the Amsler grid are recommended.”
Perspective
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CSC is widely known as a self-limiting condition; however, the long-term sequelae are not fully understood. This recent cohort study reported almost a fivefold increased risk of exudative AMD development over 5 years in patients with a history of CSC.
CSC is part of the pachychoroid disease spectrum, and it has been hypothesized that a hyperpermeable pachychoroid may be associated with choriocapillaris loss leading to ischemia, retinal pigment epithelium (RPE) stress and the characteristic sub-RPE fluid accumulation. This pathogenesis correlates to the findings in the study, suggesting that RPE breakdown and ischemic changes in CSC may be a predisposing factor for the development of choroidal neovascularization.
A potential limitation of the study is that patients diagnosed with CSC are more likely to have established medical care, eliciting a greater chance of early exudative AMD detection compared to patients who may not seek care until symptoms arise. Additionally, individual risk factors for AMD such as diet, smoking and UV protection were not taken into account.
Despite the self-limiting nature of CSC, the corresponding increased risk of exudative AMD demonstrated in this study highlights the importance of continued examinations augmented with home self-screening strategies for close monitoring long after CSC resolution, especially in older patients. Continuum of care for earlier disease detection and timely treatment are key to preserving vision for our patients.
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