This is a more zoomed in photo than we normally show. This late 30s male patient came in at 9AM sharp this morning (tiny details may seem insignificant but we will revisit this later). He said for 1.5 months, he noticed a circular dark circle in his vision out of his left eye and it is still visible when he closes his eyes. Based on his occupation (that I will not disclose), I immediately asked if he is stressed out. And the patient said “yes.” In the back of my head, I immediately thought about Central Serous Retinopathy.

Slit lamp microscopy revealed tiny white dots in the center of the eye and a well demarcated dark ring around the macula in the left eye (the photo presented on the right as if the patient is facing you). Our Compass coherent retinal camera captured it perfectly and we confirmed CSR.

Further directed questioning confirmed a Type-A Personality, a stressful job—in an industry disproportionately upturned by the pandemic—, and long term steroid cream use. We recommended the patient reassess his ability to handle stress and consider lifestyle changes regarding stress and his outlook on life. We decided to NOT consider changing his steroid cream use until he consult the doctor that Rx’ed that cream and we don’t consider it to be a major cause since he has been using the steroid cream nearly all his life. There is always a possibility that the steroid cream may contribute and that the small contribution of the steroid cream PLUS the contribution of a Type-A personality, and the stress contribution of the COVID-19 pandemic put this patient over the threshold to produce CSR.

We scheduled a three month follow-up and no medical intervention because the patient’s vision is currently not considered vision-threatening. He scheduled his follow-up at 9AM also. Patients with Type-A Personality often tend to be morning people. Males are afflicted with CSR nearly 5x as prevalently as females.

The patient left our office much relieved he has an answer and said he was shocked at the connection between stress and the diagnosis. I recounted to the patient that the discovery of the connection between stress and heart disease was discovered serendipitously by a cardiologist who had his waiting room furniture absolutely ruined by his fidgety patients in a very short amount of time and that small things can result in huge impacts.