Minnesota Flyer - Serving Midwest Aviation Since 1960

By James D. Latkin PhD MD
CFI CFII MEI Airline Transport Pilot FAA Senior Medical Examiner 

Central Serous Retinopathy: AKA Blind as a Bat!

 

November 1, 2018



One morning a while ago, a pilot friend awoke and noticed his eyesight was funny. His Venetian blinds looked wavy instead of straight. It seemed that colors weren’t as vivid as they should be. Things seemed a little fuzzy in one eye. He went barreling over to his eye doc and was told he had central serous retinopathy (CSR). This is caused by fluid buildup between the retina and its underlying support on the back of the eye. This leads to a partial a separation of the retina, causing the visual disturbances our pilot experienced.

CSR is a fairly common problem, occurring most frequently in males age 20 to 55. It is uncommon among African-Americans but may be particularly severe among Asians and Hispanics. It is often seen in Type A personalities in high stress activities. Does that sound like someone you might meet at the FBO?

Other things that seem to predispose to CSR are high blood pressure and obstructive sleep apnea. The common denominator of all these conditions is an increase in circulating epinephrine or adrenaline.

Adrenaline affects the blood circulation underneath the retina. It can increase the tendency for fluid to leak out of capillaries, causing retinal detachment. Another predisposing factor is the use of cortisone-type steroid medications. They increase the sensitivity of retinal blood vessels to the effects of adrenaline.

In one reported study, it was found that over 50 percent of folks that ended up with CSR had used steroids within the previous month.

The good news is that most detachments resolve spontaneously. About 80 to 90 percent of patients will recover eyesight to 20/25 or better. Of course, if you are trying for a First or Second Class medical, you have to get down to 20/20, so that can be a big problem for commercial pilots.

Even with the return of good central vision, many folks still notice some trouble with color vision and distortion. Rarely, pilots may have persistent trouble with night vision.

As I said, most CSR spontaneously resolves. For the 10 to 20 percent that don’t, there are several proposed treatments. I’m not an ophthalmologist, but from what I’ve read, there doesn’t seem to be an agreement on the treatment of choice.

The use of a diuretic, spironolactone seems promising. Surgical intervention with a laser is recommended for those people with a detachment persisting more than four months, having recurrent CSR or those with previous CSR in the other eye. Obviously an airman with central serous retinopathy needs to be evaluated and followed by a certified ophthalmologist with expertise in the field. In other words, don’t count on your friendly walk in clinic at the drugstore!

CSR can recur. Some suggestions to reduce the chance of that happening include lifestyle modification, i.e. reducing stress. Good luck with that if you’re flying out of LAX at 0500! Controlling blood pressure and staying away from steroid medications may also help.

As you might expect, if you have CSR the FAA wants to know about it. As with any process that interferes with vision and may be progressive, you should ground yourself until things have resolved.

When your eye doctor thinks you have achieved recovery to the best corrected visual acuity you’re going to get, it’s time to submit an 8500-7 Form, which is a report of eye examination. You will have to see or correct to 20/20 distant for a First or Second Class Medical; 20/40 for a Third Class.

The FAA will want all pertinent medical information and a current status report. They may write back requesting additional studies but, if you stick with it, one of two things will happen. Either they’ll issue a medical certificate outright and caution you to let them know if the condition returns or they will put you on a Special Issuance with the requirement of periodic eye re-examination before renewing your medical. In either event, you’ll be back in the cockpit again!

Fly wisely. See you next month.

 

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