Imaging biomarkers associated with visual acuity in central serous chorioretinopathy: a multimodal analysis

To assess the relationship between best-corrected visual acuity (BCVA) and multimodal imaging findings including optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) in patients diagnosed with central serous chorioretinopathy (CSC).

We retrospectively analyzed 249 eyes of 164 patients with CSC. OCT parameters included central macular thickness (CMT), neurosensory and pigment epithelial detachments, outer retinal integrity, and degenerative changes. FA and ICGA findings were also evaluated. Associations between multimodal imaging features and BCVA were analyzed.

BCVA differed significantly among CSC subgroups (p < 0.001), with the sequelae group showing the best visual acuity. CMT varied across subgroups (p < 0.001) and was negatively correlated with BCVA in the overall cohort, driven primarily by acute cases. Outer retinal alterations on OCT and angiographic markers of disease activity were associated with worse BCVA. In multivariable analysis, intraretinal and/or subretinal hyperreflective dots, cystoid macular degeneration, FA leakage, and choroidal neovascularization remained independent predictors of poorer visual acuity.

Visual acuity in CSC varies across disease subtypes and is associated with distinct OCT, FA, and ICGA features. These findings highlight the value of multimodal imaging in the assessment of visual prognosis and in supporting individualized follow-up and treatment strategies in CSC.