Treatment and Monitoring of Central Serous Chorioretinopathy in Pilots.

BACKGROUND: Central serous chorioretinopathy (CSC), which has the characteristics of a serous retinal detachment (SRD) in the macular area, affects mostly men in the 30- to 50-yr age range. Some patients have persistent SRD, which may cause retinal thinning and photoreceptor impairment. CSC symptoms are gradual vision loss and/or metamorphopsia. Some commercial airline pilots are concerned about CSC symptoms, which can disqualify them from flying for months and can also reoccur. Thus, careful monitoring and treatment of CSC are critical for pilots, especially those with chronic or recurrent CSC. The Federal Aviation Administration requires uncorrected distant visual acuity in the better eye to be 20/200 or better, with correction to 20/20 or better employing lenses of no greater power than ± 3.5 diopters spherical equivalent. Multimodal imaging modalities such as spectral domain optical coherence tomography (SD-OCT) allow early detection of CSC noninvasively. Moreover, half-dose verteporfin photodynamic therapy (PDT) can cure CSC in the early stage.

CASE REPORTS: Five male Japanese commercial airline pilots with CSC are presented. Four of these five pilots had been disqualified from flying for several months, but after receiving half-dose PDT, they were ultimately able to resume flying commercial aircraft.

DISCUSSION: Half-dose PDT can rapidly reduce serous subretinal fluid in CSC eyes. Recurrent and/or chronic CSC is seen in clinical cases. Therefore, continuous observation by SD-OCT after half-dose PDT is essential, even if the patient's vision recovers. Early, i.e., before visual acuity decreases, treatment is highly recommended.Shinojima A, Mori R, Fujita K, Yuzawa M. Treatment and monitoring of central serous chorioretinopathy in pilots. Aerosp Med Hum Perform. 2016; 87(12):1041-1044.