Improvement in Central Serous Chorioretinopathy Following Multiwavelength Photobiomodulation Treatment – Case Report

Central serous chorioretinopathy (CSCR) is an ocular condition characterized by serous detachment of the retinal pigment epithelium (RPE) and venous congestion of choroidal outflow and fluid buildup/leakage. Visual disturbances include blurred central vision, wavy lines, and color vision distortions. While spontaneous resolution with relatively good visual outcomes may occur, some patients show irreversible functional and anatomical changes in the retina. Optimal treatment strategies for patients with CSCR are under debate. Treatment approaches include invasive strategies such as laser photocoagulation (at risk of scotoma and choroidal neovascularization), standard photodynamic therapy, and anti-VEGF injections [1, 2].

Photobiomodulation (PBM) is a non-invasive biotechnology that utilizes wavelengths of light directed to target tissues for a multitude of beneficial effects that impact cellular outputs. These cellular effects appear to primarily activate components of the mitochondria regulating bioenergetic output with secondary effects observed in a multitude of signaling cascades involved in cellular protection, inflammatory response, and oxidative stress management [3‐6]. PBM has been used across medical indications including dermal, neurological, and musculoskeletal applications. Across indications, the target tissue for treatment differs, e.g., brain tissue vs. muscle tissue, and this impacts the PBM parameters needed to ensure appropriate dosing. Given the underlying disease pathology and mechanisms of PBM, it is postulated that PBM treatment may be beneficial in patients presenting with CSCR, which would focus the targeted treatment on ocular tissue [5, 7, 8]. The current case report explored the utility of PBM in a single patient with CSCR.

A 39-year-old female patient presented to the clinic with blurred vision in the left (OS) eye. Baseline best-corrected visual acuity (BCVA) was 85 letters in the right eye (OD), 65 letters in the left (OS) eye and central retinal thickness (CRT) was 535 μm. A clinical diagnosis of CSCR was posited for the OS eye. The clinical plan was to observe ocular status over the following few weeks.

At the 3-week follow-up visit, vision in the patient had further declined in the OS eye with BCVA scoring reduced two lines on the early treatment diabetic retinopathy study (ETDRS) chart to 55 letters and CRT had increased to 544 μm. Fluorescein angiography was performed, confirming CSCR diagnosis (Fig. 1), and treatment options discussed initiation of multiwavelength photobiomodulation (PBM) therapy using the Valeda® Light Delivery System (LumiThera Inc, Poulsbo, WA, USA). Multiwavelength PBM consisted of 590-, 660-, and 850-nm wavelengths delivered by light-emitting diodes (LED). Each treatment took < 5 min.

The patient received PBM treatment after the observation period showed continued ocular decline. PBM treatment (Tx) followed the standard protocol utilized in the sponsored LIGHTSITE randomized, controlled trials (RCT), which was 3 × per week/3–5 weeks for a total of nine treatment sessions per series. By week 1 (following 3 PBM Tx sessions), vision subjectively started to improve. OCT imaging showed significant reductions in fluid build-up in the RPE from 544 to 367 μm. At the start of the third week (following six PBM Tx sessions) BCVA scores had improved to 70 letters and OCT imaging showed near-complete resolution of fluid with a CRT score of 284 μm. After the PBM series had completed, fluid was completely resolved (CRT 231 μm) and BCVA scored at 80 letters (Fig. 2).

The patient elected to have a repeat PBM treatment ~ 6 months from the previous one. Her vision has remained stable, and no fluid is present on OCT scan. The patient was seen again ~ 1 year later with maintained BCVA and no fluid detection (Table 1).

Written informed consent was obtained from the patient for the use of her medical records in writing this case report. Formal ethics approval was not required for the completion of this case report.

The current report details the first exploration of the use of PBM in a single female patient with a diagnosis of unilateral CSCR of the left eye. Her visual function was significantly disrupted with declining BCVA and blurred vision at the first visit. The patient was started on multiwavelength PBM treatment using Valeda and displayed immediate benefits (< 1 week following PBM initiation) and complete resolution of clinical and anatomical deficits by the end of the treatment series. Furthermore, this patient’s vision and pathological status has remained stable extending out ~ 1 year post-PBM treatment. The patient has elected to pursue repeat PBM treatments highlighting interest and perceived benefit of the treatment. The patient reported that her vision subjectively continued to improve after the second series of PBM treatment.

Acute episodes of CSCR generally resolves within 3–6 months. If fluid persists beyond this period, it is typically called chronic CSCR. Chronic CSCR is at risk for more serious and permanent visual damage [9]. Visual disturbances lasting 3–6 months for acute episodes significantly affect patient quality of life (QoL) and vision during this timeframe. A treatment approach that can immediately resolve CSCR is beneficial to reduce this impact on patient QoL and outcomes in acute episodes. Furthermore, treatment resolution of cases that may transition to chronic CSCR is highly of interest.

PBM treatment has gained interest in the field of ophthalmology due to its mechanistic actions and recent studies showing benefits in a variety of indications including age-related macular degeneration [10‐20]. The threat of vision loss and the limited/invasive treatment strategies available in many ocular conditions, including CSCR, results in extreme stress and diminished outlook in many patients. The non-invasive nature of PBM coupled with its favorable mechanistic actions present a possible treatment option that is also cost-effective compared to other medical treatments. Previous studies evaluating the effect of multiwavelength PBM using Valeda have likewise shown a reduction in fluid in patients with diabetic macular edema (DME) [8]. Kaymak et al. report reductions in central retinal thickness, resolution of intraretinal fluid, and improvement in diabetic retinopathy severity scale scores following multiwavelength PBM treatment in patients with early stage DME with good vision. Furthermore, other clinical reports support positive effects on edema following PBM treatment in several ocular disease states [7, 21‐25]. Across medical indications, and more notably across trials in ophthalmic indications, PBM shows a positive safety profile with no signs of phototoxicity or serious concerns related to treatment [20, 22, 26].

Inherent to all case reports, the evaluation in a single patient presents with limitations. CSCR is a complicated pathology where certain cases resolve spontaneously, whereas others are non-resolving and require treatment before permanent loss of vision can occur [9]. This variation in outcome resolution makes it difficult to interpret true treatment effect. Due to the potential irreversible loss of vision, it is worthwhile to explore new treatments, as we have done in this single patient report, and confirm initial reports with larger clinical trials designed to assess their safety and effectiveness. This case provides the first report detailing the use of PBM in CSCR, where resolution of symptoms was observed immediately during PBM treatment. Future studies are necessary to confirm the effect of PBM in CSCR. Dependent on further investigation, PBM may represent a novel, noninvasive treatment approach with an excellent safety profile for this patient population.