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Sympathetic-parasympathetic activity and reactivity in central serous chorioretinopathy: a case-control study
Hem Kumar Tewari1, Ritu Gadia, Deepak Kumar
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences and Department of Physiology, New Delhi, India.
Purpose:
This case-control study was conducted to evaluate autonomic function activity and reactivity in patients with central serous chorioretinopathy (CSCR), because stress and type A personality, known risk factors, are also related to autonomic nervous system activity.
Methods:
Patients with CSCR were selected from the outpatient department and medical retina services in one center. Control subjects were chosen from the healthy subjects of similar age group. The autonomic activity (both sympathetic and parasympathetic) in 45 patients with CSCR was evaluated and compared with that in 28 healthy control subjects, by using HRV (heart rate variability) analysis according to the guidelines laid down by the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Autonomic reactivity (both sympathetic and parasympathetic) was also evaluated in 32 patients with CSCR and compared with that in 28 healthy control subjects, by using standard autonomic function tests: HRV, as a measure of the resting sympathetic and parasympathetic activity (tone), and changes in blood pressure response and heart rate changes during various stressor stimuli in the tests as a measure of sympathetic and parasympathetic reactivity.
Results:
Patients with CSCR showed significantly decreased parasympathetic activity (P = 0.002), significantly increased sympathetic activity (P = 0.005), and significantly increased sympathetic-parasympathetic balance (P = 0.004) as measured from different measures of beat-to-beat heart rate variability. The patients also showed significantly decreased parasympathetic reactivity (P = 0.03). Sympathetic reactivity showed a trend toward lessening.
Conclusions:
Autonomic function, both activity and reactivity components of sympathetic and parasympathetic system, is impaired in patients with CSCR. Because autonomic supply modulates the choroidal blood flow, there may be a correlation between measures of autonomic function and the presence of CSCR.
