old CSR not detected in fluorescein angiogram???

[Engineer75]

Hello, I'm a 33 year old computer programmer and electronic engineer. I almost work 10-14 hours a day with computer. I think I have type A personality. a week ago while I was rubbing my right eye I suddenly noticed computer writings became blurred. when I look at distant objects with my left eye I see them dissolving in their background, for example for a black object in white backgrounds it looks like if someone holds a flashlight on them and moves it slowly, when the flash light is on the object I only see light not any darkness but when it moves around I sometimes see the dark object. I immediately visited an eye specialist and after examining my left eye, my visual acuity was 5/10(20/40 half of normal). he said that there is 90% chance that I have CSR. for confirmation he send me to perform a Fluorescein Angiography and also advised me to reduce stress. Well, I did that. In eye clinic that I had my Fluorescein Angiography test, there was another eye specialist who also examined my left eye and he said both the fluorescein photographs and his examination show that my eye is OK and he dose not see any problem.I returned my fluorescein angiogram + digital photography of retina to my doctor and he said that I have to perform yet another test , Perimetry. well I did that and returned the result to my doctor.he said he still dose not know what my problem is but he suspects an old CSR. he referred me to another doctor for consultation. I really don't want to lose my sight. Can it be an old CSR that did not showed up in fluorescein angigraphy?
thank you very much!

[Engineer75]

Hello, I saw my new doctor and after seeing my medical documents he said that I have Retrobulbar Neuritis and I have to see a neurologist. Now his diagnosis is different from first doctor diagnosis. Should i go and see a neurologist or should I see yet another Ophthalmologist? can please professionals take a more close look at my documents that attached to this post and tell me what to do?

thank you very much

PS- I have no pain.

[Engineer75]

Thanks a million time Dr.Pernoud for your comment. I don't know anything about medicine but I looked at my photos very closely. In digital photography of retina there is a pale yellow line under macula(I hope I refer to it with its correct name, I mean big black spot). My doctor said this line is abnormal and he dose not know what it is. Also I saw many digital photographs of CSR patient on internet and in those pictures there is a pale area surrounding macula. I examined my photo with great precision(It can be seen only if you zoom on macula)and it can be seen that I have also a pale region surrounding macula. I told this to my doctor but he didn't say anything. also macula is not homogeneous and there are  some red regions inside it, I again told this to my doctor and asked could it be hemorrhage and he said if it was, it was apparent in angiography. All I can say for sure is that 3-4 months ago I had not this problem because in that time there were many electronic boards that I had purchased and I had to check for short circuits in them. and I usually do this using both my eyes because one eye will be tired soon and because it needs very great precision I certainly would notice immediately if there was slightest weakness in one of my eyes. Since I've noticed a problem in my left eye. I have downloaded an HOTV chart from internet and I check my eye sight many times a day. One interesting and hopefully good indication is that after I wake up from sleep I can see better. I am sure that first that I had installed HOTV chart I couldn't read 20/32(10/16) line I only could read 20/40(10/20) line but this morning and yesterday's afternoon after waking up from sleep I could read 20/32(10/16) line while it was not very clear but I could read it but after working for some time with my eyes reading 20/32(10/16) line becomes harder, now that I type this message I barely can read  20/32(10/16)  line and I'm not sure if I can say I have passed this line as I said earlier it looks that those writings dissolving  in their background if I've given enough time(a few minutes) I sometimes can see them. certainly in my next appointment I will tell my new doctor if he thinks it is helpful to perform  an OCT.

Thank again for your care and time,
best wishes for you

[Joan M Pernoud, MD]

Sorry, I did not realize that you had your actual fluorescein and visual field here for me to see. I'm impressed.

The visual field looks reduced and the fluorescein does have what appears to be pigment mottling in the middle so that does look like it could be CSR at some stage. Central serous retinopathy can recur so it would be helpful to also get an OCT of the macula and see if there is some kind of swelling remaining. If it is really resolved, your vision will remain unchanged but if it is still in resolution, it definitely could improve. It is amazing how easy it is not to notice diminished vision in a non-dominant eye if the dominant eye is seeing well as you did when you rubbed your best seeing eye. Hope your consultant can get more answers for you. Make sure you bring a list of questions with you.

[Joan M Pernoud, MD]

I am not a retinal subspecialist and therefore I am not sure what an old CSR looks like on fluorescein. I know that it would not look like an active lesion where fluid leaks into the retina and the retina is ballooned out with fluorescein. Usually there is a line around the macula (the retina which is responsible for central vision) where the edge of the fluid was after the fluid resolved.

In any event, old CSR does not cause the symptoms you have and I believe it won't take the new consultant too long to discover what the problem is because of your rather pronounced symptoms.

You did not say if your symptoms are constant or periodic. If they are periodic, it could be a migraine aura which would also match your personality type. Just a thought.