When Acute CSCR Resolves but Vision Does Not: Predictors of 20/20 Recovery — MICRoN Report 13

Acute central serous chorioretinopathy (CSCR) often resolves without intervention, but disappearance of subretinal fluid (SRF) is not synonymous with restoration of 20/20 vision. This MICRoN Report 13 asks which baseline clinical and imaging features are associated with failure to reach 20/20 best-recorded visual acuity (BRVA) after a first, untreated, spontaneously resolved episode.

Multicenter retrospective observational cohort from the Macula Society International CSCR Research Network (MICRoN): 195 eyes of 189 patients with a single episode of acute CSCR and documented complete spontaneous SRF resolution. Eyes with recurrent, persistent, or chronic disease, recognized chronic sequelae, active treatment, or major competing visual pathology were excluded. Symptom duration at presentation was up to 24 weeks; minimum follow-up was three months. Mean age was 45.45 ± 10.84 years. Six patients contributed both eyes.

Outcomes were defined as final BRVA ≥20/20 versus <20/20 (20/25 or worse). Acuity was recorded with current spectacles and pinhole confirmation, rather than a uniformly standardized protocol-refraction endpoint.

108/195 eyes (55.38%) reached 20/20 or better after fluid resolution; 87/195 (44.62%) did not. Nevertheless, 83.58% reached at least 20/30 and 92.8% at least 20/40. Thus, the stringent 20/20 threshold detects residual limitations that would be missed by broader definitions of favorable visual recovery.

Patients with final acuity below 20/20 were older (49.6 versus 42.1 years) and had worse baseline median BRVA (0.30 versus 0.15 logMAR). Follow-up was longer in the poorer-outcome group (median 24.21 versus 12.68 months), complicating unadjusted comparisons.

• Older age: adjusted odds ratio (OR) 1.074 per year (95% CI 1.028–1.112; P = .001).
• Worse presenting BRVA: adjusted OR 1.369 per 0.1-logMAR increase (95% CI 1.152–1.627; P < .001).
• Bilateral CSCR: adjusted OR 4.115 (95% CI 1.329–12.74; P = .014).
• Presence of serous PED: adjusted OR 0.299 (95% CI 0.094–0.947; P = .040), associated with lower odds of failure; conversely, absence of PED marks a less favorable profile.

These are associations, not causal effects. Odds ratios must not be described as risk ratios or as validated individual prognostic probabilities. The PED finding is hypothesis-generating and needs external validation.

Eyes ultimately reaching 20/20 had greater mean baseline subfoveal choroidal thickness (392.5 versus 345.0 µm; P = .002), central retinal thickness (212.7 versus 193.1 µm; P = .016), and inner choroidal thickness (102.0 versus 83.0 µm; P < .001). Uniform photoreceptor outer-segment (PROS) elongation was more frequent with favorable recovery (67.6% versus 42.5%), whereas speckled PROS morphology was more frequent with poorer recovery (35.6% versus 13.0%). Serous PED was present in 24.1% versus 9.2% (P = .008).

Importantly, thickness measures and PROS morphology did not remain independently predictive in the reported multivariable model. They are descriptive imaging associations, not validated stand-alone decision rules. Imaging availability varied: autofluorescence in 181 eyes and fluorescein angiography in 61 eyes.

Follow-up ellipsoid-zone (EZ) integrity tracked functional recovery: a continuous EZ was reported in 86.1% of the ≥20/20 group versus 54.0% of the <20/20 group (P < .001). Discontinuous or atrophic EZ patterns were concentrated among poorer-outcome eyes. This is a post-resolution correlate, not a baseline predictor available at initial presentation.

The anatomical–functional discordance underscores why SRF resolution alone is an insufficient endpoint for counseling or follow-up.

For an untreated first episode of acute CSCR, observation remains an accepted initial approach in appropriately selected patients. At presentation, older age, worse BRVA, bilateral involvement, and absence of serous PED may justify more guarded visual prognostication. Documenting baseline and follow-up OCT outer-retinal structure is useful, but these findings do not demonstrate that earlier photodynamic therapy, laser, or other intervention changes final visual outcome: treated eyes were excluded.

Assess function after SRF clears, and consider ongoing symptoms even when conventional acuity is relatively good. The study did not measure contrast sensitivity, metamorphopsia, microperimetry, or patient-reported quality of life.

• Selection on spontaneous resolution: only untreated eyes whose SRF resolved were analyzed; findings cannot be generalized to persistent, recurrent, treated, or chronic CSCR, and cannot estimate the likelihood of spontaneous resolution.
• Retrospective multicenter ascertainment: variable refraction/BRVA capture, visit schedules, imaging availability, and residual ocular comorbidities may influence the 20/20 classification.
• Outcome dichotomization: a strict 20/20 threshold is clinically interpretable but collapses a range of visual performance and does not capture quality-of-vision complaints.
• Clustering: six participants contributed both eyes; the report does not clearly establish adjustment for within-person correlation in its logistic regression.
• Possible overfitting and imprecision: several candidate predictors were considered in 195 eyes, and confidence intervals for bilateral involvement and PED are wide; external validation and calibration were not reported.
• Data-reporting caution: the paper gives 34 bilateral cases in the <20/20 group and also labels this 60.9%, although 34/87 is 39.1%; this inconsistency should be checked against source records before using subgroup percentages. The adjusted bilateral OR is quoted as reported.
• Temporal ambiguity: post-resolution EZ integrity is associated with outcome but cannot be treated as an independent baseline prognostic biomarker.
• Unmeasured functional outcomes: no standardized contrast sensitivity, microperimetry, metamorphopsia or patient-reported outcome data; unrecognized interim recurrences are possible.

Fluid-free does not necessarily mean 20/20. In this selected multicenter cohort, nearly 45% of eyes failed to reach 20/20 despite spontaneous SRF resolution. Age, baseline acuity, bilaterality, and serous PED status were independently associated with the dichotomized outcome. These findings can inform measured patient counseling, but require prospective external validation and do not justify changing treatment timing by themselves.