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  • Systemic steroids continue to be prescribed for CSC despite potential risks

    Comprehensive Ophthalmology, Retina/Vitreous

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    Review of: Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis

    Azad A, Zhou M, Afshar A, et al. Ophthalmology, in press

    The purpose of this retrospective study was to analyze the frequency of systemic corticosteroid prescription before and after central serous chorioretinopathy (CSC) diagnosis.

    Study design

    This claims-based analysis included 3,418 commercial insurance beneficiaries who had CSC and received care between 2007 and 2015. The study population was limited to individuals diagnosed with CSC by an eye care provider and excluded patients with other major ophthalmologic comorbidities. For controls, researchers developed a non-CSC cohort (n=17,178) that was matched according to age, sex, general health and geographic region. The primary outcome was frequency of systemic corticosteroid prescriptions among CSC patients within 12 months before and at 6, 12 and 24 months after diagnosis, median time to steroid initiation and discontinuation, and odds of receiving steroids after diagnosis.

    Outcomes

    Approximately 39% of patients with CSC were prescribed systemic steroids at some point during the study period compared with 23% of matched controls. Within the CSC cohort, over 12% received steroids in the year before diagnosis while 12% received treatment in the year after; patients receiving steroids postdiagnosis tended to be steroid naïve. Compared with the control group, patients with CSC tended to have longer median time to both first postdiagnosis steroid prescription (1.8 vs. 0.5 years) and last steroid prescription (1.6 vs. 0.35 years). Although patients with CSC were less likely to receive steroids 6 months after diagnosis (OR 0.72), they were more likely to receive steroids by 2 years (OR 1.24). Prescribing patterns were similar among ophthalmologists and optometrists.

    Limitations

    Educational efforts may have improved since the study period, which was 5 to 13 years ago.

    Clinical significance

    Many patients continue to be prescribed systemic corticosteroids after CSC diagnosis, despite evidence suggesting steroids contribute to CSC development. This study highlights a need for greater collaboration among providers to ensure that clinical practices reflect evidence-based recommendations.