Viagra: The Rise is in the Eye of the Pill-Holder

This week's photos aren't as gory as last week's Worm in the Eye, but they are fascinating nevertheless.

There is a retinal disorder called "Central Serous Retinopathy" (or simply CSR). In this disorder, the thin layer of nerves and blood vessels that coats the inside of the eye - the retina - forms a fluid-filled elevation -- a blister. It happens right in the area of the macula which is that specialized part of the retina that sees the clearest and is used for your straight ahead central vision. So, it's "Central" because it involves the central vision, it's "Serous" because it's a blister, and it's "Retinopathy" because it's a disorder of the retina.

In the photo, I've marked the outline of the blister with arrows, and on the cross sectional Ocular Coherence Tomography ("OCT") below, you can clearly see the elevation of the retina and the fluid in the blister, which shows up as black. The thickness chart below shows a green zone which would be the normal contour of the macula, and the black line which marks the actual elevation of this macula -- plenty elevation. (The OCT is amazing technology. It's been around for about 3 or 4 years, and we purchased one when the units became commercially available. It's revolutionized the practice of ophthalmology. We can see things that we simply could not see before. It's like a very high resolution CT scan of the eye, but uses light instead of X-rays, to capture the images. If you want to see it in action, stop by Marianas Eye Institute.)

Central Serous Retinopathy blurs the vision, sometimes causing objects to appear "morphed" (straight lines appear curved, people look like cartoons). It usually occurs in one eye, but can affect both eyes. It comes on for no apparent reason, usually in men in their 30's and 40's. It goes away without treatment over a 3-6 month period, and usually the vision returns to normal though sometimes it can remain slightly blurred. In rare circumstances when it doesn't resolve, we can find the area of leaking, blast it with a laser, and speed up the resolution of the blister.

Over the past year, we've been seeing a lot more of Central Serous Retinopathy. Recently an association between Viagra use and CSR has been reported. Take Viagra, and the elevation of the retina occurs. Stop Viagra and it goes away. Use Viagra again, and it comes back. There is no clear explanation, but now we ask everyone with CSR if they are using Viagra.

A weird bit of eye news worth sharing.