Increased Risk of CSCR Observed in Spring, Fall

Although the underlying mechanisms remain un­clear, CSCR appears to exhibit temporal dynamics, evidenced by an increased risk of disease onset in spring and autumn months compared with summer. Future research to elucidate these seasonal patterns may help guide preventative strategies and timely clinical intervention. Photo: Mohammad Rafieetary, OD. Click image to enlarge. It's been shown that systemic factors such as corticosteroid use, psychological stress and hyper­tension contribute to the onset of central serous chorioretinopathy (CSCR), but some studies suggest that broader environmental influences, in­cluding seasonal variation, may play a role in its development. In a recent study, researchers reviewed and analyzed the evidence on seasonal variation in CSCR incidence and found that disease risk increased in spring and fall. While the precise underlying mechanisms remain unclear, researchers theorize that the observed patterns may be related to factors such as choroidal thickness, daylight exposure and stress.A systematic search was conducted across 10 databases in June 2025. Eligible studies included observa­tional designs reporting CSCR incidence or frequency across seasons; case re­ports and reviews were excluded. Five studies, with 907 participants in total, met the inclusion criteria. Three studies with sufficient data were included in quantitative meta-analysis, while the remaining two conference abstracts were included in the qualitative synthesis.Seasonal variation in CSCR incidence was reported across studies; the meta-analysis, which used summer as the reference season, showed a significantly increased incidence of CSCR in spring and autumn. No sig­nificant difference was found for winter.Seasonal variation may reflect environmental or behavioral factors, such as stress levels, sleep pat­terns, exposure to sunlight or hormonal fluctuations. Seasonality has also been documented in psychiatric outcomes. Suicidality among adolescents, for instance, peaks in spring and autumn, suggesting that psycho­social stressors change with the seasons and could contribute indirectly to CSCR variation. “Even in the absence of CSCR or any ophthalmological diseases, a recent systematic review revealed an association be­tween choroid alterations and psychiatric disorders, including anxiety, insomnia and depression,” the authors wrote in their paper.Another potential contributor is allergy-related seasonality, as seasonal allergic rhini­tis peaks in spring and extends into summer. Corticosteroid use, including nasal sprays, is commonly used to treat these conditions and is known as the most important CSCR risk factor. However, the authors noted in their paper, the pathophysiology of CSCR remains complex and multi­factorial, and it is not yet completely elucidated.For in­stance, a previous study observed the highest incidence of CSCR in spring and hypothesized that the lower CSCR incidence in summer may be associated with increased water evaporation from the body, which may influence choroidal homeostasis. “Moreover, their study also dis­cussed seasonal variation in choroidal vascular perme­ability, which is often thought to be essential in CSCR pathogenesis, as a possible biological mechanism,” the authors explained in their paper.Mediators released during allergic inflam­mation, such as histamine, prostaglandins and catechol­amines, may also alter choroidal vascular permeability and thereby contribute to CSCR onset. “Increased plasma levels of epinephrine and norepinephrine have been ob­served in patients with acute CSCR, and these were cor­related with macular thickness and visual acuity,” the authors wrote about findings from a previous study. Similarly, another study emphasized that both corticosteroids and catecholamines may have addi­tive effects on the choroidal circulation and RPE. “This is because corticosteroids can enhance vasoconstrictive re­sponses mediated by catecholamines, leading to the sensitization of choroidal vessels or the RPE to the effects of endogenous catecholamines, thereby promoting vascular hyperpermeability and contributing to CSCR development,” the authors explained in their paper.Due to the variability of study designs, the retrospective nature of most included studies and the limited geographical representation, future pro­spective studies across diverse regions with more consis­tent diagnostic criteria are necessary, the authors noted in their paper. “Understanding the temporal dynamics of CSCR may provide valuable insights into its pathogenesis and generate future preventative strategies, patient education programs and timely clin­ical interventions, particularly during high-risk periods,” the authors concluded.Click here for the journal source. Ferdiko Hutamadella IM, Ornberg E, Breazzano MP, et al. Seasonal variation in the incidence of central serous chorioretinopathy: a systemic review and meta-analysis. November 22, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.