A story about an ESPN reporter who is being treated for Central Serous Retinopathy (CSR) was widely circulated yesterday, bringing to the public’s attention an ultimate mind/body interaction showcasing the intimacy between function and structure. Way back when I was Chief of the VT Service at SUNY, it was common knowledge that the best retinal specialist in the world was Lawrence Yannuzzi, a pioneer in fluorescein angiography. Whenever there was a puzzling retina case, even our in-house retina experts Drs. Sherman and Bass would say: “Let’s get them over to Larry”.
Dr. Yannuzzi was among the first to make the direction connection between stress and CSR (also termed CSC – Central Serious Chorioretinopathy). From the abstract of his paper published in the journal Retina in 1987:
“The hypothesis suggests that the eyes as an organ system, and the macula as an ultimate target area, can be intermittently or continuously stimulated adversely by Type A behavior and its physiological consequences, most notably a sympathetic discharge. The multifactorial concept alludes to other potential risk factors such as age, race, sex, refractive state, or unknown tissue susceptabilities. The pathogenesis implies an inter-relationship between finely balanced components of a complex biopsychological system involving an individual’s genetic endowment, his environment, and his behavioral pattern.“
Since 1987, other risk factors have emerged for CSR. But stress, particularly as related to personality types, has remained high on the list and is apparently what swamped Britt McHenry’s right macula.
Darrell Baskin completed a vitreoretinal fellowship at Wills Eye in Philly,and he put together a nice three part YouTube series about CSR. At the 4 minute mark of Part 1, Dr. Baskin cites work by Dr. Yannuzzi showing that 60% of CSR patients have Type A personality compared to only 18% of Type B patients. At the 6 minute mark, a subsequent study by another group is presented showing character traits highlighted by risk avoidance, quick-temper, frustration, insecurity, and anticipatory anxiety. Dr. Baskin comments: “And not much you can change that I know of in my central serous patients, so I don’t really go into detail on that character inventory”. A behavioral optometrist might view the malleability of character inventories differently, and partner in some instances with a professional who can provide counseling, but in any event the three part video is very well done and worth watching in its entirety.