Optical Coherence Tomography Biomarkers in Acute Central Serous Chorioretinopathy: Relationship Between Subretinal Fluid Height and Logmar Visual Acuity

OBJECTIVES To evaluate the clinical significance of specific spectral-domain optical coherence tomography (SD-OCT) features, specifically subretinal fluid (SRF) height and retinal pigment epithelial (RPE) alterations, in predicting visual acuity (VA) outcomes in patients presenting with acute central serous chorioretinopathy (CSCR). METHODOLOGY This cross-sectional study, conducted at the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, evaluated 50 consecutive patients with acute CSCR. The sample size was statistically powered to detect a moderate-to-strong correlation (r ≥ 0.39). Maximum subretinal fluid (SRF) height was measured quantitatively. Qualitative parameters included the frequency and location of pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) bumps. Snellen VA was converted to continuous LogMAR units for parametric analysis. Relationships were evaluated using Pearson correlation coefficients (r). RESULTSThe study population comprised 50 male patients with a mean age of 36.50 ± 7.42 years (SD) (range: 25-50 years). A strong, statistically significant positive correlation was observed between maximum SRF height and degraded visual acuity (r = 0.907, P < 0.001). Patients with minimal SRF height (0–200 µ, n=29, 58%) maintained baseline LogMAR vision between 0.00 and 0.30, whereas the maximum recorded SRF height (933 µ) corresponded to a severe visual reduction (LogMAR > 1.30). Concurrently, PEDs were identified in 40% (n=20) of the cohort (28% single, 12% multiple; 14% subfoveal, 26% extrafoveal), and RPE bumps were noted in 64% (n=32). No statistically significant correlation was identified between visual impairment and the presence (r = 0.063, P = 0.666), frequency (r = 0.074, P = 0.608), anatomical site (r = 0.074, P = 0.607) of PEDs, or the presence of RPE bumps (r = 0.024, P = 0.807). CONCLUSION In acute CSCR, visual acuity degradation is primarily driven by the physical height of subretinal fluid accumulation beneath the fovea. Secondary microstructural modifications of the RPE such as isolated pigment epithelial detachments or fine RPE contour irregularities show no immediate statistical correlation with baseline visual acuity within this cohort size.