December 2014
Volume 55, Issue 12
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Multidisciplinary Ophthalmic Imaging  |   December 2014
Optical Quality in Central Serous Chorioretinopathy
Author Affiliations & Notes
  • Kyungmin Lee
    Department of Ophthalmology and Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea
    HanGil Eye Hospital, Incheon, Korea
  • Joonhong Sohn
    HanGil Eye Hospital, Incheon, Korea
  • Jong Gil Choi
    HanGil Eye Hospital, Incheon, Korea
    Department of Optometry, Seoul National University of Science and Technology, Seoul, Korea
  • Sung Kun Chung
    Department of Ophthalmology and Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea
  • Correspondence: Sung Kun Chung, Department of Ophthalmology and Visual Science, St. Paul's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea; eyedoc@catholic.ac.kr
Investigative Ophthalmology & Visual Science December 2014, Vol.55, 8598-8603. doi:10.1167/iovs.14-14679
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      Kyungmin Lee, Joonhong Sohn, Jong Gil Choi, Sung Kun Chung; Optical Quality in Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(12):8598-8603. doi: 10.1167/iovs.14-14679.

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Abstract

Purpose.: To assess optical quality and intraocular scattering using the Optical Quality Analysis System (OQAS) in central serous chorioretinopathy (CSC) and to determine the effects of retinal changes on optical quality.

Methods.: This was a prospective, case-control study. Participants were 29 patients with diagnosis of CSC. The control group consisted of the patients' unaffected eyes. Initial logMAR visual acuity, central macular thickness (by spectral domain optical coherence tomography), and optical quality parameters including modulation transfer function (MTF) cutoff frequency, Strehl (2-dimensional) ratio, and OQAS values at 100%, 20%, and 9% contrast levels were investigated. Objective scattering index (OSI) at 4.0-mm pupil size was assessed in both eyes by using the OQAS. After 3 months of treatment, which included observation and focal laser or injections of antivascular endothelial growth factor, every CSC-affected eye was followed. Main outcome measures were differences between clinical parameters of the CSC-affected eye and those of the control eye and changes in those parameters according to the clinical course of CSC over 3 months.

Results.: In CSC-affected eyes, the MTF cutoff was significantly reduced (P = 0.01), and OSI was significantly increased (P = 0.03). As macular thickness decreased, OSI decreased but did not become normalized compared to the control eye, nor was it statistically significantly correlated with central macular thickness change.

Conclusions.: Retinal change affected optical quality and intraocular scatter. Therefore, when the severity of a cataract is assessed using the OQAS, retinal status should be considered when interpreting OQAS values.

Introduction
Vision can be assessed in terms of visual acuity and visual quality. Visual quality can be expressed as optical quality, composed of ocular scatter, aberration, and diffraction. In order to correct vision, it is important to evaluate not only visual acuity but also optical quality. Recently, different kinds of aberrometers have been developed to detect ocular aberrations.1,2 However, these instruments can only detect aberrations in transparent ocular medium, and they can sometimes underestimate optical quality because they do not assess parameters such as scatter. Furthermore, because in most of these systems the same route used for the inlet of the initial beam is also used as the outlet for detection, the aberrometers can overestimate aberrations. In order to solve these problems, the Optical Quality Analysis System (OQAS; Visiometrics, Terrassa, Spain) was developed.3 
The OQAS uses a double-pass method whereby different routes are used for the inlet of the initial laser beam and the outlet of the detection mirror, thus preventing confusion between induction and detection beams. It is the only commercially available device that enables measurement of the effects of optical aberration and the effects of loss of ocular transparency on the optical quality of the human eye.35 OQAS detects retinal image quality by using a retinal point spread function, which is captured from the inner retinal surface. Numerous studies have shown that ocular quality is influenced by both aberration and scattering. However, no studies have investigated the changes in or influences on ocular quality if the retina itself is not normal. Thus, we were curious as to whether OQAS values would remain unchanged in the presence of abnormal lesions in the retina without any other optical problems. 
Central serous chorioretinopathy (CSC) is a disorder characterized by serous retinal detachment and/or retinal pigment epithelium (RPE) detachment, with changes most often confined to the macula, and associated with leakage of fluid through the RPE into the subretinal space.6 It reportedly affects mostly men in their fourth to fifth decades, with most cases reported in patients from 45 to 51 years of age.7,8 Despite advances in imaging techniques and numerous studies of the disease, the pathophysiology of CSC remains poorly understood. Its clinical course is quite varied, but acute CSC is usually self-limiting in that visual acuity typically recovers within 1 to 3 months without visual sequelae, although recurrences are common.911 
In this study, we assessed optical quality and intraocular scattering in acute CSC patients who were in either an active disease state or a resolved disease state by using the OQAS, with the aim of obtaining new reference data to assist clinical diagnosis. In addition, we analyzed the effects of retinal change on optical quality by means of objective parameters including modulation transfer function (MTF) cutoff frequency and Strehl ratio; OQAS values (OV) at contrast levels of 100%, 20%, and 9%; and objective scattering index (OSI). 
Methods
This prospective, nonrandomized, case-control study included patients who had an acute attack of CSC between August 2011 and February 2012, presenting at the HanGil Eye Hospital, Incheon, Korea. The study protocol followed guidelines of the Declaration of Helsinki and was approved by the relevant institutional review board and the Clinical Research Ethics Committee of HanGil Eye Hospital. All patients provided informed consent for participation in the study. 
Inclusion and Exclusion Criteria
Acute onset CSC was defined as CSC that was clinically evident after spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FAG), and dilated fundus examination, with symptoms having been present for less than 3 months. Exclusion criteria included a history of CSC in either eye; severe dry eye syndrome, defined as a tear break-up time of less than 5 seconds; clinically significant cataract presenting with a lens opacities classification system (LOCS) III grade of more than 3; retinal comorbidity such as diabetic retinopathy, retinal vein occlusion, or macular degeneration; and any other ocular comorbidity that might affect optical medium, such as corneal opacity or dystrophy. Patients with a history of amblyopia, hyperfluorescence on FAG in the contralateral eye, or more than 1 diopter (D) of astigmatism were also excluded. The experimental and control groups consisted of the CSC-affected eye and the unaffected eye (which did not show any change in the retina), respectively, of each patient. The endpoint of the study was 3 months after the treatment. 
Patient Examination
A complete ocular examination, SD-OCT, FAG, and OQAS assessment for a 4.0-mm pupil were performed at the initial visit and at 3 months after the treatment in both eyes. Visual acuity was evaluated with a Snellen chart and expressed as a fixed number. Central macular thickness was assessed by using SD-OCT (OPKO/OTI Ophthalmic Technologies, Inc., Toronto, ON, Canada). Thickness was double-checked by the retinal specialist (K. M. L.) manually to confirm the value from the report of SD-OCT. Spherical equivalent was calculated as  where each of these errors was evaluated by using an Auto Ref-Keratometer (RK-5, Canon, Inc., Tokyo, Japan). The optical quality parameters included objective refraction error, MTF cutoff frequency, Strehl ratio, OSI, and OV (at 100%, 20%, and 9% contrast, using the OQAS) for a 4.0-mm pupil. The manifest refractive error of the subjects was fully corrected during these measurements. Spherical error (up to −8 D) was automatically corrected by the double-pass system, and the residual spherical error (more than −8 D) and cylindrical error were corrected with an external lens because the uncorrected refractive error directly affects the optical outcome of the system.  
Treatment of Acute CSC
Treatment of acute CSC was dependent on patient status and demand. Observation was recommended for at least 1 month. After 1 month of observation, several options were recommended such as focal laser photocoagulation, intravitreal bevacizumab injection, or further observation. All potential risks and benefits of each treatment were explained to the patients. 
Intravitreal injections of bevacizumab (Avastin, 25 mg/mL; Genentech, Inc., South San Francisco, CA, USA) were given after applying at least three drops of topical anesthetic (Alcaine; Alcon, Aliso Viejo, CA, USA). After disinfection and draping, a 0.05-mL volume containing 1.25 mg of bevacizumab was injected into the vitreous cavity, using a 30-gauge needle at a distance of 3.0 to 3.5 mm from the limbus, according to lens status. After the injection, a topical antimicrobial drug, levofloxacin ophthalmic solution (Cravit; Santen Pharmaceutical Co., Ltd., Osaka, Japan) was administered 4 times a day for a week. 
Focal laser photocoagulation was applied at the leaking point, which was detected by FAG. The Patterned Scanning Laser (PASCAL; OptiMedica Corp., Santa Clara, CA, USA) was used for treatment. Direct treatment of the leaking spot was conducted by using burns of 100 to 200 μm in diameter, unless the leak was immediately under the subfoveal area. Intensity and duration of the laser burns varied between 150 and 250 mW and 20 and 30 ms respectively. 
Statistical Analysis
Data are means ± standard deviations. The Mann-Whitney U test was used for statistical comparisons between the CSC-affected group and the control group at the initial visit and between the CSC-affected group after 3 months of treatment and the control group at the initial visit. The Wilcoxon signed rank test was used to compare initial and posttreatment clinical data in the CSC-affected group. Spearman's ρ correlation coefficient was used to evaluate the relationships between central macular thickness changes and changes in optical quality parameters in the CSC-affected group after treatment. Statistical analyses were performed using SPSS version 17.0 software (SPSS, Inc., Chicago, IL, USA), and P values of <0.05 were considered statistically significant. 
Results
Table 1 shows baseline characteristics of the 29 patients enrolled in this study, of whom 79% were male, and the mean age was 47 years. The most common symptom of CSC was central scotoma, which was present in 72% of patients. Initial OCT showed as serous subretinal detachment or pigment epithelial detachment (PED) or a combination of these for 66% of patients, 3% of patients, and 31% of patients, respectively. Twenty-eight patients (97%) had subfoveal serous subretinal detachment. Most of the patient with PED on OCT had subfoveal involvement, except for 2 patients. With regard to treatment, 52% of the patients underwent observation for 3 months, 34% underwent focal laser treatment at the leakage point as indicated by FAG, and 14% received intravitreal injections of antivascular endothelial growth factor (anti-VEGF). Treatment failure was suspected in 10% of the 29 patients after 3 months. Among 3 patients with treatment failure, 2 patients had choroidal neovascularization after focal laser, which required continued intravitreal anti-VEGF injection. 
Table 1
 
Demography and Baseline Characteristics
Table 1
 
Demography and Baseline Characteristics
Characteristic of CSC Patients Value
Total number of patients 29
Ratio of males to females, % 23:6 (79%)
Age, y 47.1 ± 7.1
No. of patients with a history of smoking, % 13 (45%)
No. of patients with a history of steroid medication, % 2 (7%)
Main symptom
 Central scotoma 21 (72%)
 Metamorphopsia 3 (10%)
 Micropsia 4 (14%)
 Nonspecific 1 (4%)
OCT configuration
 SRF 19 (66%)
 Combination of SRF and PED 9 (31%)
 PED only 1 (3%)
Treatment
 Observation 15 (52%)
 Focal laser 10 (34%)
 Intravitreal anti-VEGF injection 4 (14%)
Failure of treatment 3 (10%)
2 showed secondary CNV (+)
1 showed unresolved SRF
Table 2 summarizes mean values for visual acuity, central macular thickness, optical quality parameters, and results of Mann-Whitney testing comparing the CSC-affected group with the control group at initial presentation. Visual acuities assessed by logMAR were 0.20 ± 0.26 in the CSC-affected group and 0.02 ± 0.04 in the control group (P < 0.05), and central macular thicknesses were 420.7 ± 163.5 μm and 210.2 ± 22.3 μm, respectively (P < 0.05). All parameters investigated except spherical equivalent and width at 50% contrast level differed statistically significantly between the 2 groups. 
Table 2
 
Differences Between CSC-Affected and Control Groups at Presentation
Table 2
 
Differences Between CSC-Affected and Control Groups at Presentation
Parameter Affected Group Control Group P Value
Initial Snellen chart visual acuity 0.71 ± 0.29 0.96 ± 0.07 0.001*
Initial logMAR visual acuity 0.20 ± 0.26 0.02 ± 0.04 0.001*
Central macular thickness, μm 420.7 ± 163.5 210.2 ± 22.3 0.00*
Spherical equivalent 0.08 ± 1.16 −0.20 ± 1.15 0.281
Optical quality
 Objective refraction error 0.86 ± 0.76 −0.06 ± 0.93 0.00*
 OSI 2.60 ± 2.35 0.68 ± 0.31 0.00*
 MTF cutoff 28.21 ± 14.13 37.30 ± 10.22 0.009*
 Strehl ratio 0.24 ± 0.44 0.20 ± 0.06 0.029*
 Width at 50% 5.20 ± 4.31 3.52 ± 1.37 0.061
 Width at 10% 20.98 ± 14.91 11.91 ± 4.11 0.001*
 OV at 100% contrast 0.94 ± 0.47 1.24 ± 0.34 0.009*
 OV at 20% contrast 0.67 ± 0.40 0.90 ± 0.29 0.015*
 OV at 9% contrast 0.40 ± 0.27 0.55 ± 0.19 0.014*
Table 3 summarizes the changes in visual acuity, central macular thickness, and optical quality parameters in the CSC group after treatment for 3 months. Visual acuity (logMAR) was improved to 0.11 ± 0.11 (P = 0.001) after the treatment. According to optical quality as assessed by the OQAS, objective refraction error, OSI, width at 50%, and width at 10% changed to 0.54 ± 1.09 (P = 0.002), 1.95 ± 1.45 (P < 0.001), 5.05 ± 3.93 (P = 0.018), and 22.62 ± 14.70 (P < 0.001), respectively. 
Table 3
 
Change of Clinical Parameter After Treatment in the CSC-Affected Group
Table 3
 
Change of Clinical Parameter After Treatment in the CSC-Affected Group
Parameter At Presentation 3 Months After Treatment P Value
Initial Snellen chart visual acuity 0.71 ± 0.29 0.80 ± 0.19 0.001*
Initial logMAR visual acuity 0.20 ± 0.26 0.11 ± 0.11 0.001*
Central macular thickness, μm 420.7 ± 163.5 253.8 ± 90.3 0.166
Spherical equivalent 0.08 ± 1.16 0.00 ± 1.24 0.144
Optical quality
 Objective refraction error 0.86 ± 0.76 0.54 ± 1.09 0.002*
 OSI 2.60 ± 2.35 1.95 ± 1.45 0.000*
 MTF cutoff 28.21 ± 14.13 32.74 ± 14.78 0.231
 Strehl ratio 0.24 ± 0.44 0.19 ± 0.09 0.706
 Width at 50% 5.20 ± 4.31 5.05 ± 3.93 0.018*
 Width at 10% 20.98 ± 14.91 22.62 ± 14.70 0.000*
 OV at 100% contrast 0.94 ± 0.47 1.09 ± 0.49 0.226
 OV at 20% contrast 0.67 ± 0.40 0.79 ± 0.40 0.300
 OV at 9% contrast 0.40 ± 0.27 0.49 ± 0.27 0.484
Table 4 summarizes correlations between changes in central macular thickness and OQAS optical quality parameters in CSC-affected eyes after treatment for 3 months at follow-up. Central macular thickness decreased by 35.4 ± 26.68 μm. All optical quality parameters and visual acuity improved after treatment for 3 months, but none of these changes was statistically significantly correlated with central macular thickness change. 
Table 4
 
Correlation Between Change of Central Macular Thickness and OQAS Parameter
Table 4
 
Correlation Between Change of Central Macular Thickness and OQAS Parameter
Parameter Change Value % of Central Macular Thickness Change −35.4 ± 26.68
Coefficient Factor P Value
Visual acuity −0.12 ± 0.21 0.332 0.105
Objective refractive error −0.19 ± 0.62 −1.05 0.618
OSI, % 2.31 ± 12.8 0.210 0.314
MTF cutoff, % 44.86 ± 98.74 0.204 0.328
Strehl ratio, % 47.02 ± 82.91 0.275 0.183
In width at 50%, % 7.04 ± 61.37 0.020 0.924
In width at 10%, % 12.33 ± 54.21 −0.015 0.942
OV at 100% contrast 0.18 ± 0.50 0.198 0.342
OV at 20% contrast 0.39 ± 0.42 0.289 0.162
OV at 9% contrast 0.09 ± 0.33 0.300 0.145
Table 5 summarizes the differences in visual acuity, central macular thickness, and optical quality as assessed by OQAS between the control group and the CSC-affected group after treatment. Although central macular thickness normalized, changing to a mean of 253.8 ± 90.3 μm, statistically significant differences between the 2 groups remained with regard to visual acuity (P = 0.004), OSI (P < 0.001), and width at 10% (P = 0.01). 
Table 5
 
Differences Between CSC Affected Group and Control Group After the Treatment
Table 5
 
Differences Between CSC Affected Group and Control Group After the Treatment
Parameter Control Group Affected Group After Treatment P Value
Initial Snellen chart visual acuity 0.96 ± 0.07 0.80 ± 0.19 0.004*
Initial logMAR visual acuity 0.02 ± 0.04 0.11 ± 0.11 0.004*
Central macular thickness, μm 210.2 ± 22.3 253.8 ± 90.3 0.125
Spherical equivalent −0.20 ± 1.15 0.00 ± 1.24 0.61
Optical quality
 Objective refraction error −0.06 ± 0.93 0.54 ± 1.09 0.035*
 OSI 0.68 ± 0.31 1.95 ± 1.45 0.000*
 MTF cutoff 37.30 ± 10.22 32.74 ± 14.78 0.491
 Strehl ratio 0.20 ± 0.06 0.19 ± 0.09 0.778
 Width at 50% 3.52 ± 1.37 5.05 ± 3.93 0.146
 Width at 10% 11.91 ± 4.11 22.62 ± 14.70 0.01*
 OV at 100% contrast 1.24 ± 0.34 1.09 ± 0.49 0.485
 OV at 20% contrast 0.90 ± 0.29 0.79 ± 0.40 0.362
 OV at 9% contrast 0.55 ± 0.19 0.49 ± 0.27 0.522
Discussion
In this study, subretinal fluid accumulation induced transient reductions in MTF cutoff frequency and Strehl ratio and increases in OSI and width at 10%. Notably, the latter two optical parameters as determined by the OQAS did not completely recover to normal values, although the subretinal fluid disappeared. Although the authors did not show the values in the results, the optical parameters by the OQAS were not statistically correlated with macular thickness itself. Moreover changes in these optical parameters were not statistically correlated with changes in central macular thickness. These results indicate that optical quality measurements taken by the OQAS, which is based on a double-pass technique, including intraocular scattering of the eyes, are influenced by retinal status. OQAS-derived values are not dependent on retinal status, but the results of this study are incongruent with this contention. To our knowledge, this is the first study to assess the optical quality of the eye in detail, including intraocular scattering, which involves a transient change in the retina. Artal et al.12 reported that OSI value was significantly correlated with the LOCS III system, in which if macular thickness in SD-OCT was normal, it could be used as an index of cataract severity to determine cataract surgery. In our study, however, even where macular SD-OCT images appeared normal, the patient's OSI value was sometimes increased, as if they had cataract, even though their lens status was clear, if they had previously had CSC. Therefore, when interpreting OSI value as an indicator of the severity of cataract, retinal state should be considered, as should the possibility of a medical history of retinal disease, to prevent overestimation. 
According to our observations, the photoreceptor inner segment/outer segment (IS/OS) junction may play an important role in determining aspects of optical quality, especially OSI, in the eye. Two patients serve as examples of this observation (Figs. 1 and 2), and both exhibited a similar course. After 1 month of observation, subretinal fluid had disappeared, central macular thickness had decreased to a normal level, and visual acuity had improved, but the OSI value remained relatively unchanged. Macular SD-OCT images at that time suggested that the IS/OS junction was disrupted. Two months later, however, the IS/OS junction had recovered to normal, and subsequently, the OSI value decreased to a nearly normal level. 
Figure 1
 
A 46-year-old woman presented with central scotoma in the left eye for 2 months. A fundus examination showed serous elevation under the macular area. SD-OCT in the left eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area, with OSI of 1.5, confirmed as CSC in the left eye by FAG at initial evaluation. After 1 month of observation, the patient's visual acuity improved to 0.8, and SD-OCT showed resolved CSC appearance; although OSI was still high, 1.4, and the patient still complained about visual dissatisfaction. At this time, IS/OS junction was disrupted on SD-OCT. After 2 months, visual acuity was almost stable, but the patient was happy about her eye. At that time, her OSI had improved to 0.5, and SD-OCT showed restoration in the IS/OS junction.
Figure 1
 
A 46-year-old woman presented with central scotoma in the left eye for 2 months. A fundus examination showed serous elevation under the macular area. SD-OCT in the left eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area, with OSI of 1.5, confirmed as CSC in the left eye by FAG at initial evaluation. After 1 month of observation, the patient's visual acuity improved to 0.8, and SD-OCT showed resolved CSC appearance; although OSI was still high, 1.4, and the patient still complained about visual dissatisfaction. At this time, IS/OS junction was disrupted on SD-OCT. After 2 months, visual acuity was almost stable, but the patient was happy about her eye. At that time, her OSI had improved to 0.5, and SD-OCT showed restoration in the IS/OS junction.
Figure 2
 
A 56-year-old man presented with blurry vision in the right eye for 1 month. Fundus examination showed serous round elevation under the macular area. SD-OCT in the right eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area with an OSI of 1.4, which was confirmed as CSC in the right eye by FAG at initial evaluation. After 1 month of observation, the visual acuity was stable, and SD-OCT showed resolved CSC appearance, but OSI was still as high as 1.4, and the patient still complained about blurry vision. At that time, the IS/OS junction was disrupted on SD-OCT; however, after 2 months, visual acuity had improved to 0.9, and the patient denied any blurriness in his eye sight. At that time, his OSI improved to 0.6, and SD-OCT showed restoration in the IS/OS junction.
Figure 2
 
A 56-year-old man presented with blurry vision in the right eye for 1 month. Fundus examination showed serous round elevation under the macular area. SD-OCT in the right eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area with an OSI of 1.4, which was confirmed as CSC in the right eye by FAG at initial evaluation. After 1 month of observation, the visual acuity was stable, and SD-OCT showed resolved CSC appearance, but OSI was still as high as 1.4, and the patient still complained about blurry vision. At that time, the IS/OS junction was disrupted on SD-OCT; however, after 2 months, visual acuity had improved to 0.9, and the patient denied any blurriness in his eye sight. At that time, his OSI improved to 0.6, and SD-OCT showed restoration in the IS/OS junction.
In our study, OSI did not return to normal values after the resolution of subretinal fluid. This may be related to an observation in several previous studies that retinal sensitivity did not recover to a normal state after the resolution of subretinal fluid.1316 Many studies have reported that changes seen with multifocal electroretinography corresponded predominantly with areas of clinically apparent disease17 and that its amplitudes improved markedly after resolution of subretinal fluid leakage but never returned to normal levels.1820 Ojima et al.21 compared retinal sensitivity as measured by microperimetry with SD-OCT and found that retinal sensitivity in areas of RPE irregularity or IS/OS disruption was significantly reduced. Usually, retinal sensitivity improved with treatment and with resolution of subretinal fluid leakage, but it did not return to normal levels, even in patients with perfect vision. Recently, rapid advances in adaptive optics technology have enabled imaging of photoreceptor layers in the retina. Ooto et al.22 examined CSC eyes with an adaptive optics scanning laser ophthalmoscope. They examined eyes with resolved subretinal fluid leakage in a cohort of patients who had had acute CSC that had resolved spontaneously. Eyes with resolved CSC had fewer cones per square millimeter than control eyes. They reported this dramatic loss of photoreceptors in a cohort where most patients had 20/20 or better vision. This may explain our observation that OSI values did not tend to normalize, despite subretinal fluid resolving. Results of the current study also suggest that retinal sensitivity is one of the key factors affecting optical quality as measured by the OQAS. 
This study had several limitations. The sample size was small, and the follow-up period was limited to 3 months. There was no positive control with hyperopia. We evaluated whether the optical parameters measured by the OQAS were related to PED location or treatment modalities, and the results showed no statistical differences, suggesting that it could be due to small sample size. Nonetheless, this is the first study focused on optical quality in patients whose CSC had resolved. Numerous previous studies evaluated changes in SD-OCT images in patients with resolved CSC patients and suspected photoreceptor damage. The authors hope to use technology to learn more about photoreceptor damage and optical quality changes, which can be another problem in benign retinal disease. It should also be emphasized that when interpreting OSI value as an indicator of cataract severity, retinal state should also be accurately evaluated, to prevent overestimation. 
Acknowledgments
Presented in oral form at the 27th Annual Meeting of the Asian Pacific Academy of Ophthalmology Congress in April 2012. 
The authors alone are responsible for the content and writing of the paper. 
Disclosure: K. Lee, None; J. Sohn, None; J.G. Choi, None; S.K. Chung, None 
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Ooto S Hangai M Sakamoto A High-resolution imaging of resolved central serous chorioretinopathy using adaptive optics scanning laser ophthalmoscopy. Ophthalmology. 2010; 117: 1800–1809. [CrossRef] [PubMed]
Figure 1
 
A 46-year-old woman presented with central scotoma in the left eye for 2 months. A fundus examination showed serous elevation under the macular area. SD-OCT in the left eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area, with OSI of 1.5, confirmed as CSC in the left eye by FAG at initial evaluation. After 1 month of observation, the patient's visual acuity improved to 0.8, and SD-OCT showed resolved CSC appearance; although OSI was still high, 1.4, and the patient still complained about visual dissatisfaction. At this time, IS/OS junction was disrupted on SD-OCT. After 2 months, visual acuity was almost stable, but the patient was happy about her eye. At that time, her OSI had improved to 0.5, and SD-OCT showed restoration in the IS/OS junction.
Figure 1
 
A 46-year-old woman presented with central scotoma in the left eye for 2 months. A fundus examination showed serous elevation under the macular area. SD-OCT in the left eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area, with OSI of 1.5, confirmed as CSC in the left eye by FAG at initial evaluation. After 1 month of observation, the patient's visual acuity improved to 0.8, and SD-OCT showed resolved CSC appearance; although OSI was still high, 1.4, and the patient still complained about visual dissatisfaction. At this time, IS/OS junction was disrupted on SD-OCT. After 2 months, visual acuity was almost stable, but the patient was happy about her eye. At that time, her OSI had improved to 0.5, and SD-OCT showed restoration in the IS/OS junction.
Figure 2
 
A 56-year-old man presented with blurry vision in the right eye for 1 month. Fundus examination showed serous round elevation under the macular area. SD-OCT in the right eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area with an OSI of 1.4, which was confirmed as CSC in the right eye by FAG at initial evaluation. After 1 month of observation, the visual acuity was stable, and SD-OCT showed resolved CSC appearance, but OSI was still as high as 1.4, and the patient still complained about blurry vision. At that time, the IS/OS junction was disrupted on SD-OCT; however, after 2 months, visual acuity had improved to 0.9, and the patient denied any blurriness in his eye sight. At that time, his OSI improved to 0.6, and SD-OCT showed restoration in the IS/OS junction.
Figure 2
 
A 56-year-old man presented with blurry vision in the right eye for 1 month. Fundus examination showed serous round elevation under the macular area. SD-OCT in the right eye showed subretinal fluid with serous retinal detachment beneath the perifoveal area with an OSI of 1.4, which was confirmed as CSC in the right eye by FAG at initial evaluation. After 1 month of observation, the visual acuity was stable, and SD-OCT showed resolved CSC appearance, but OSI was still as high as 1.4, and the patient still complained about blurry vision. At that time, the IS/OS junction was disrupted on SD-OCT; however, after 2 months, visual acuity had improved to 0.9, and the patient denied any blurriness in his eye sight. At that time, his OSI improved to 0.6, and SD-OCT showed restoration in the IS/OS junction.
Table 1
 
Demography and Baseline Characteristics
Table 1
 
Demography and Baseline Characteristics
Characteristic of CSC Patients Value
Total number of patients 29
Ratio of males to females, % 23:6 (79%)
Age, y 47.1 ± 7.1
No. of patients with a history of smoking, % 13 (45%)
No. of patients with a history of steroid medication, % 2 (7%)
Main symptom
 Central scotoma 21 (72%)
 Metamorphopsia 3 (10%)
 Micropsia 4 (14%)
 Nonspecific 1 (4%)
OCT configuration
 SRF 19 (66%)
 Combination of SRF and PED 9 (31%)
 PED only 1 (3%)
Treatment
 Observation 15 (52%)
 Focal laser 10 (34%)
 Intravitreal anti-VEGF injection 4 (14%)
Failure of treatment 3 (10%)
2 showed secondary CNV (+)
1 showed unresolved SRF
Table 2
 
Differences Between CSC-Affected and Control Groups at Presentation
Table 2
 
Differences Between CSC-Affected and Control Groups at Presentation
Parameter Affected Group Control Group P Value
Initial Snellen chart visual acuity 0.71 ± 0.29 0.96 ± 0.07 0.001*
Initial logMAR visual acuity 0.20 ± 0.26 0.02 ± 0.04 0.001*
Central macular thickness, μm 420.7 ± 163.5 210.2 ± 22.3 0.00*
Spherical equivalent 0.08 ± 1.16 −0.20 ± 1.15 0.281
Optical quality
 Objective refraction error 0.86 ± 0.76 −0.06 ± 0.93 0.00*
 OSI 2.60 ± 2.35 0.68 ± 0.31 0.00*
 MTF cutoff 28.21 ± 14.13 37.30 ± 10.22 0.009*
 Strehl ratio 0.24 ± 0.44 0.20 ± 0.06 0.029*
 Width at 50% 5.20 ± 4.31 3.52 ± 1.37 0.061
 Width at 10% 20.98 ± 14.91 11.91 ± 4.11 0.001*
 OV at 100% contrast 0.94 ± 0.47 1.24 ± 0.34 0.009*
 OV at 20% contrast 0.67 ± 0.40 0.90 ± 0.29 0.015*
 OV at 9% contrast 0.40 ± 0.27 0.55 ± 0.19 0.014*
Table 3
 
Change of Clinical Parameter After Treatment in the CSC-Affected Group
Table 3
 
Change of Clinical Parameter After Treatment in the CSC-Affected Group
Parameter At Presentation 3 Months After Treatment P Value
Initial Snellen chart visual acuity 0.71 ± 0.29 0.80 ± 0.19 0.001*
Initial logMAR visual acuity 0.20 ± 0.26 0.11 ± 0.11 0.001*
Central macular thickness, μm 420.7 ± 163.5 253.8 ± 90.3 0.166
Spherical equivalent 0.08 ± 1.16 0.00 ± 1.24 0.144
Optical quality
 Objective refraction error 0.86 ± 0.76 0.54 ± 1.09 0.002*
 OSI 2.60 ± 2.35 1.95 ± 1.45 0.000*
 MTF cutoff 28.21 ± 14.13 32.74 ± 14.78 0.231
 Strehl ratio 0.24 ± 0.44 0.19 ± 0.09 0.706
 Width at 50% 5.20 ± 4.31 5.05 ± 3.93 0.018*
 Width at 10% 20.98 ± 14.91 22.62 ± 14.70 0.000*
 OV at 100% contrast 0.94 ± 0.47 1.09 ± 0.49 0.226
 OV at 20% contrast 0.67 ± 0.40 0.79 ± 0.40 0.300
 OV at 9% contrast 0.40 ± 0.27 0.49 ± 0.27 0.484
Table 4
 
Correlation Between Change of Central Macular Thickness and OQAS Parameter
Table 4
 
Correlation Between Change of Central Macular Thickness and OQAS Parameter
Parameter Change Value % of Central Macular Thickness Change −35.4 ± 26.68
Coefficient Factor P Value
Visual acuity −0.12 ± 0.21 0.332 0.105
Objective refractive error −0.19 ± 0.62 −1.05 0.618
OSI, % 2.31 ± 12.8 0.210 0.314
MTF cutoff, % 44.86 ± 98.74 0.204 0.328
Strehl ratio, % 47.02 ± 82.91 0.275 0.183
In width at 50%, % 7.04 ± 61.37 0.020 0.924
In width at 10%, % 12.33 ± 54.21 −0.015 0.942
OV at 100% contrast 0.18 ± 0.50 0.198 0.342
OV at 20% contrast 0.39 ± 0.42 0.289 0.162
OV at 9% contrast 0.09 ± 0.33 0.300 0.145
Table 5
 
Differences Between CSC Affected Group and Control Group After the Treatment
Table 5
 
Differences Between CSC Affected Group and Control Group After the Treatment
Parameter Control Group Affected Group After Treatment P Value
Initial Snellen chart visual acuity 0.96 ± 0.07 0.80 ± 0.19 0.004*
Initial logMAR visual acuity 0.02 ± 0.04 0.11 ± 0.11 0.004*
Central macular thickness, μm 210.2 ± 22.3 253.8 ± 90.3 0.125
Spherical equivalent −0.20 ± 1.15 0.00 ± 1.24 0.61
Optical quality
 Objective refraction error −0.06 ± 0.93 0.54 ± 1.09 0.035*
 OSI 0.68 ± 0.31 1.95 ± 1.45 0.000*
 MTF cutoff 37.30 ± 10.22 32.74 ± 14.78 0.491
 Strehl ratio 0.20 ± 0.06 0.19 ± 0.09 0.778
 Width at 50% 3.52 ± 1.37 5.05 ± 3.93 0.146
 Width at 10% 11.91 ± 4.11 22.62 ± 14.70 0.01*
 OV at 100% contrast 1.24 ± 0.34 1.09 ± 0.49 0.485
 OV at 20% contrast 0.90 ± 0.29 0.79 ± 0.40 0.362
 OV at 9% contrast 0.55 ± 0.19 0.49 ± 0.27 0.522
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