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Risk factors for incident central serous retinopathy: case–control analysis of a US national managed care population
  1. Maggie Zhou1,
  2. Sophie J Bakri2,
  3. Suzann Pershing1,3
  1. 1 Stanford University School of Medicine, Stanford, California, USA
  2. 2 Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California, USA
  1. Correspondence to Dr Suzann Pershing, Stanford University School of Medicine, Stanford, CA 94305, USA; pershing{at}


Aim To evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR).

Methods Using national insurance databases, we conducted a case–control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460).

Results The mean age (SD) of cases was 49.1 (12.2) years, and the majority (69.2%) were male. Cases were more likely to have received steroids in the past year (OR 1.14, 95% CI 1.09 to 1.19, p<0.001) and to have comorbid Cushing’s syndrome (OR 2.19, 95% CI 1.33 to 3.59, p=0.002), age-related macular degeneration (OR 5.24, 95% CI 5.00 to 5.49, p<0.001), diabetic macular oedema (OR 2.05, 95% CI 1.71 to 2.47, p<0.001) and diabetes mellitus (OR 1.44, 95% CI 1.33 to 1.56, p<0.001). Glaucoma was associated with lower odds of CSR (OR 0.54, 95% CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR.

Conclusions Male middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously hypothesised risk factors did not appear to confer increased risk. More research is needed to confirm and examine underlying pathophysiology.

  • epidemiology
  • ophthalmology
  • central serous retinopathy

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  • Contributors All authors were involved in the conception and design of the study. All authors were involved in the analysis and interpretation of data. All authors were involved in the literature research and writing the first drafts of the manuscript. All authors critically revised the manuscript and gave final approval of the submitted manuscript. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The authors had full access to all the date in the study and take full responsibility for the integrity and accuracy of the data, as well as the decision to submit for publication. All authors approved the manuscript and its submission.

  • Funding Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health, National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and by an internal Stanford funding.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The MarketScan Databases contain only de-identified data, and therefore our analysis was determined exempt from Institutional Review Board approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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