Women with CSCR Have Better Visual, Structural Outcomes

Progesterone may confer a degree of protection in women that tempers CSCR severity, researchers say. Its absence in men combined with anatomical differences results in the greater frequency and severity of CSCR in men, this paper argues. Photo: Mo Rafieetary, OD. Click image to enlarge. In a recent study, researchers evaluated the characteristics and longitudinal outcomes of chronic central serous chorioretinopathy (CSCR) in women compared to an age-matched cohort of men. They found a higher frequency of simple CSCR in women 50 years and older, which may reflect a lower burden of choroidal structural alterations. The findings were reported in American Journal of Ophthalmology.A total of 426 eyes (213 women and 213 age-matched men) with a diagnosis of CSCR from a large, multicenter dataset were included. Baseline and final best-recorded visual acuity (BRVA) and multimodal imaging parameters (e.g., RPE alterations, choroidal macular thickness, subfoveal choroidal thickness, subretinal fluid, pigment epithelial detachment, double layer sign, hyperreflective dots) as well as the presence of choroidal neovascularization (CNV) and subretinal hyperreflective material were assessed. Women demonstrated better visual acuity than men, consistent with earlier studies reporting milder baseline dysfunction in female patients with CSCR. Men showed a more complex structural phenotype, characterized by larger areas of RPE alteration, greater frequency of peripapillary RPE changes, longer double layer sign and broader pigment epithelial detachments. These findings agree with a previous study that recently described higher rates of diffuse RPE alterations, diffuse leakage and RPE tracts in men. “Similar patterns have been associated with increased choroidal vascular hyperpermeability and more aggressive disease behavior in previous imaging-based analyses of CSCR and pachychoroid disease spectrum disorders,” the authors explained in their paper. For advice on the clinical diagnosis of CSCR, see this feature. The higher frequency of simple CSCR in women aged 50 and older may reflect a lower burden of choroidal structural alterations, in line with previous reports suggesting sex-related differences and hormonal influences on choroidal regulation. These differences may also help explain the more favorable functional baseline profile observed in women.During follow-up, women achieved greater improvement in BRVA across both age groups, whereas male patients, particularly those over the age of 50, showed a higher rate of persistent subretinal fluid and more frequent recurrences. The higher persistence rate in men is consistent with a previous study demonstrating that more complex choroidal and RPE phenotypes correlate with chronicity and reduced fluid clearance.The development of CNV during follow-up substantially increased the likelihood of persistent subretinal fluid, aligning with a previous study demonstrating that choroidal neovascularization in chronic CSCR represents a major driver of prolonged fluid and poorer outcomes, the researchers explained. No significant difference was observed between men and women in that regard, the authors noted in their paper.Visual improvement was strongly influenced by baseline anatomy. Higher choroidal macular thickness, poorer initial acuity and the presence of hyperreflective dots in the choroidal stroma were associated with limited functional recovery. Furthermore, a longer duration of symptoms was likewise associated with reduced visual improvement and with an increased risk of persistent subretinal fluid, underscoring the importance of early diagnosis and timely management.Persistent subretinal fluid markedly hindered visual recovery, further highlighting the importance of timely fluid resolution. Surprisingly, gender itself did not emerge as an independent predictor of acuity improvement, suggesting that the superior outcomes observed in women are mediated through more favorable baseline structural characteristics rather than gender-specific biological mechanisms. Several hypotheses have been proposed to explain gender-specific patterns.“One of the leading theories implicates that hormonal differences may contribute to gender-specific disease behavior; in particular, progesterone, a natural antagonist of the mineralocorticoid receptor, may confer a degree of protection in women by delaying onset or mitigating disease severity,” the authors wrote in their paper. “Of note, men are consistently reported to have a higher lifetime risk of developing CSCR, whereas women typically manifest the disease later in life.”What the authors also found interesting is that women aged ≥50 years, despite the presumed reduction in estrogen-mediated hormonal protection, were more likely to present with simple forms of CSCR compared with age-matched men. “This apparent paradox suggests that hormone-mediated mineralocorticoid receptor modulation may not represent the primary driver of gender disparities in CSCR and instead supports the contribution of intrinsic anatomical factors including scleral thickness and vortex vein outflow resistance” plus differences in choroidal hemodynamics and vascular remodeling.“These findings refine the understanding of gender-specific disease behavior and may help guide personalized management strategies,” the researchers concluded in their paper. “Nonetheless, future prospective studies with balanced treatment analysis are needed to validate these observations.”Click here for the journal source. Gregori G, Kumar Sahoo N, Hasan N, et al. Demography, clinical characteristics and long-term outcomes of central serous chorioretinopathy in women. MICRoN report number Fourteen. Am J Ophthalmol. February 23, 2026. [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.