Central Serous Retinopathy Treatment

[Solreil]

Two months ago to the day I had a sudden onset of blurred central vision in my left eye. After a week of no improvement I saw an optometrist who then referred me to a specialist telling me I may have Central Serous Retinopathy. I saw this specialist two days ago and they have set me up with another appointment for that angiography dye test and who knows what (I was told the tests will take all day). The specialist then told me it's likely that they'll want to treat me with steroids..but all of the research I can find does NOT indicate that steroids should be used as a treatment method--in fact, quite the opposite, to AVOID all steroids.

My question is this: Have steroids ever been used as a -treatment- for CSR? If not, should I be concerned that the only specialist in my area wants to treat me with something every report says I should avoid?

[John C Hagan III, MD, FACS, FAAO]

Best of luck and thanks for the follow up
JCH MD

[Solreil]

I'd like to thank you and the other poster for replying. Since the diagnosis has changed, it makes my original question, although answered, irrelevant.

I agree with what you said. With the rise of patients and no increase in physicians, it does make it a bit harder to take time with each patient to answer questions and be personable.

Yes, I learned only after that it was a teaching hospital. I really had little knowledge about the hospital before that, so this is a learning experience for me as well.

Thanks. I'll take any luck I can be wished. I've already had the first injection by a Dr. Earl. He seems like a capable guy.

And with that, thanks again. I'll close this topic.

[John C Hagan III, MD, FACS, FAAO]

Yes, CSR would be better than CNV. HOWEVER the use of intraocular VEGF inhibitos has dramatically improved the odds of retaining good vision and is one of the major successes of modern ophthalmology. Usually a series of injections are necessary.

When you go to a "teaching" center you can expect to have a number of medical students, residents, fellows in the room and a lot of doctor to doctor talk.

Yes some physicians are technically expert but have miserable personalities and are uncommunitive. I have woked with this type before and I have had them been involved with my care personally. Some of my mentors and the most excellent surgeons/ophthalmologists have also been extremely kind and considerate of the patient and their family. Several told me "You may not always be able to cure your patients but you can always treat them with kindness and respect"

One of the worse problems is that many physicians, me included, like to talk and explain with patients. However with the changes in demographics (aging population) and the soon to be enacted socialized medicine we have 30M more people to take care of and no new physicians. The math is simple every physician must work longer and spend less time with each patient. I only see the situation getting worse.

Best of luck.

JCH MD

[Solreil]

Thank you for your candid response. To be honest, I felt that lack of confidence not just due to the misinformation I was told about steroids being a possible treatment for me, but just the demeanor of the appointment. It doesn't make you feel like you're in good hands when the doctor exclaims "Wow, I've never seen it look like that before!" and suddenly you're in a new room with three doctors standing over you and babbling to EACH OTHER in technical jargon without addressing you. It was especially hard when I was hearing things thrown around like "did you notice the bleeding?". That's funny, no one had told ME about bleeding. So, no, that didn't do much.
I mean no quarrel, so please understand my perspective from a patient point of view. It was just off-putting.. Plus, to be honest, most of the times I've seen doctors in the past have been negative experiences. I recognize that these are the faults of those individuals rather than the field as a whole, but it doesn't mean that it doesn't diminish any concerns I have.

My follow-up appointment and angiography was today, so I took the chance to ask about Dr. Bamba. I was told by one doctor that she was a pathologist and by another doctor that I saw that she IS a retina specialist, just not AS specialized as others. Regardless, I was assigned a different specialist this appointment whom said it was not CSR, but CNV and insisted I return tomorrow for treatment right away via injection. I received quite a bit of information in a completely different manner from the first experience, so it was a lot better than with the first doctor. He was patient, answered questions and respected the uneasiness I have when it comes to things like eyes and veins. Because of that I understand that I must not be an easy patient. Furthering that point, I'll have to be under anesthesia for the injection. Even now researching the new diagnosis, I'm a little apprehensive. The best information comes from medical studies which are a little above my understanding, but from all the layman research I can find, it makes me wish it had been the CSR.

I appreciate you recommending Dr. Rao and will keep him in mind for the future if I have any needs. So far being switched to an actual specialist who seems to know what they're doing is enough.

Thank you for your replies and assistance. It really is appreciated.

[John C Hagan III, MD, FACS, FAAO]

I don't know why you feel that way. The first "doctor" that saw you was not a MD physician, the second is at a world famous eye institution and is well trained. It is possible you do not have all the facts and itmay not be CSR OR Washington University does all kinds of medical research and there are new steroids out now. It may have been that they are doing a research study on intraocular injected steroids injected into the eye. The new Eye MD (me) gave you advice without a charge and apparently the doctor you spoke with on the phone gave you free advice.

You have a plan of action and list of questions. If you are uncomfortable with the person you're seeing there (I do not know them) see Dr. Kumar Rao I know him and he is brilliant and kind.

Not many places where you could get this type of information, this quickly. You might want to re-think the confidence issue. Discuss this whomever you see at Barnes. I think this is mis-communication. Besides you don't want to be under te care of a MD you don't have confidence in.

JCH MD

[Solreil]

Thanks! I took your advice and went a step further, contacting a clinic in another state that specializes in retinal diseases. I was able to (after a bit of trouble with the receptionist) talk to a doctor who told me that steroids is NOT a treatment option. It was suggested to me that before my next appointment I print off one of the medical journals I found online and offer it as proof to the specialist if I have any trouble.

So you had to go to three places at the least? Man. It really doesn't do much for my confidence in the medical community. :\

[Solreil]

Actually, the Washington University Center for Retinal Diseases located at Barnes Jewish in St. Louis IS where the specialist I saw is located.. It's Dr. Bamba I'm currently seeing there. I'll definitely consider asking after some of the other doctors you recommended there.

[John C Hagan III, MD, FACS, FAAO]

You are near St. Louis Missouri which has some excellent retina specialists. I would suggest you look into the group affiliated with Washington University, this includes Kumar Rao, MD who is an excellently trained retina surgeon and a kind man.

David Glaser MD and his associates are in private practice and well trained also.

It's worth the drive to get the best available, get a second opinion, and  CSR in not considered an eye emergency.

JCH MD

[Luvtoski]

I really don't have the answer to your question, but wanted to reinforce your gut feeling and do NOT blindly take what one Doctor recommends.  I went to 4 Retina Specialists before retina surgery and was totally surprised on how they each disagreed in regards to treatment plans, surgery injections, etc.

Go outside of your area or whatever it takes to get other opinions.