What are the management and treatment recommendations for individuals with central serous retinopathy, particularly those who drive commercial vehicles?

From the Guidelines

Commercial vehicle drivers with central serous retinopathy (CSR) should undergo comprehensive visual field testing and visual acuity assessment before returning to work, and treatment options may include low-dose oral eplerenone or spironolactone, photodynamic therapy with verteporfin, or subthreshold micropulse laser therapy, as recommended by the most recent evidence-based treatment guideline 1. Management of CSR for commercial vehicle drivers requires careful monitoring and treatment based on symptom severity. For mild cases, observation is recommended with regular follow-up appointments every 4-6 weeks, as most cases resolve spontaneously within 3-6 months. Commercial drivers should be advised that visual disturbances from CSR may temporarily affect their ability to drive safely, potentially requiring temporary work restrictions until vision improves. Some key points to consider in the management of CSR include:

• Treatment of hyperfluorescent areas on indocyanine green angiography (ICGA) that correspond to the area of (focal) leakage on fluorescein angiography (FA) and sub-retinal fluid on optical coherence tomography (OCT) 1.
• The use of half-dose or half-fluence photodynamic therapy (PDT) to treat the choroidal dysfunction/pachychoroid factor of the disease, although limited data are available to support this combined treatment 1.
• Lifestyle modifications, such as stress reduction techniques, minimizing corticosteroid use, maintaining healthy blood pressure, and reducing caffeine intake, are crucial in the management of CSR 1. The pathophysiology of CSR involves fluid accumulation under the retina due to dysfunction in the retinal pigment epithelium, often triggered by stress hormones and corticosteroids, which explains why stress management is a key component of treatment 1. In terms of DOT regulations, commercial drivers with CSR should be aware of the potential impact of their condition on their ability to drive safely, and should work with their healthcare provider to develop a plan for managing their condition and ensuring their safety on the road. Some key considerations for commercial drivers with CSR include:
• The potential need for temporary work restrictions until vision improves 1.
• The importance of comprehensive visual field testing and visual acuity assessment before returning to work 1.
• The need to document adequate visual function, as required by regulatory agencies 1.

From the Research

Management and Treatment Recommendations for Central Serous Retinopathy

• The most common initial approach to treating central serous retinopathy is observation, as the effects on the retina are usually self-limited 2.
• Low-quality evidence suggests that half-dose photodynamic therapy (PDT) may result in a small improvement in vision, less recurrence, and less persistent central serous chorioretinopathy (CSC) at 12 months compared to sham treatment 2.
• Photodynamic therapy, conventional laser photocoagulation, and subthreshold micropulse laser therapy have been shown to improve best-corrected visual acuity and promote subretinal fluid resolution in chronic central serous chorioretinopathy 3.
• Mineralocorticoid receptor antagonists may be a viable choice for the treatment of chronic CSC, although more research is needed to confirm their efficacy 4.

DOT Regulations for Commercial Vehicle Drivers with Central Serous Retinopathy

• There is no direct evidence in the provided studies regarding DOT regulations for commercial vehicle drivers with central serous retinopathy.
• However, it is essential to note that central serous retinopathy can cause visual disturbances, including blurred vision and decreased visual acuity, which may impact a driver's ability to operate a commercial vehicle safely.
• Drivers with central serous retinopathy should consult with their healthcare provider and follow DOT regulations regarding visual acuity and other vision standards for commercial vehicle drivers.

Treatment Options for Central Serous Retinopathy

• Observation is the most common initial approach to treatment, as many cases resolve spontaneously within 3-6 months 5.
• Focal laser therapy, either micropulse laser or argon laser coagulation, can be used to treat the leakage point visible in fluorescein angiography 5.
• Photodynamic therapy has been shown to be effective in improving visual acuity and reducing subretinal fluid in chronic central serous chorioretinopathy 3, 4.
• Systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors, or non-steroidal anti-inflammatory drugs may also be beneficial in some cases 5.