Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis.

Abstract Objective To analyze frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy (CSC) diagnosis. Design Retrospective claims-based analysis. Participants A nationally-representative sample of commercial insurance beneficiaries who received care between 2007-2015. Methods We limited the study population to beneficiaries with incident CSC diagnosed by an eye care provider, excluding those with other major ophthalmologic comorbidities. We developed a non-CSC comparison cohort matched to CSC patients on age, sex, general health (Charlson Comorbidity Index), and geographic region. We compared systemic corticosteroid prescriptions before and after CSC diagnosis and by diagnosing provider type (optometrist versus ophthalmologist), and evaluated likelihood of receiving steroids among CSC patients versus matched controls using logistic and Cox proportional hazard regression models. Main Outcome Measures Frequency of systemic corticosteroid prescriptions among CSC patients within 12 months pre-diagnosis and at 6, 12, and 24 months post-diagnosis; median time to steroid initiation and discontinuation and odds of receiving post-diagnosis steroids among CSC patients and controls. Results We identified 3418 CSC patients. Nearly 39% (n=1326) were prescribed systemic steroids at some point during the analysis period, compared to 23% of matched controls (4033 of 17,178 patients). Over 12% of CSC patients (n=430) received steroids within a year pre-diagnosis, and nearly 12% (n=404) received steroids within 1 year post-diagnosis. Most patients who received post-diagnosis steroids were steroid-naive (n=231). The most common steroid prescribed was oral prednisone (an approximately 1-month supply). Among those receiving steroids, CSC patients had longer median time to first post-diagnosis steroid prescription (1.82 years versus 0.50 years for controls) and longer time to last steroid prescription (1.62 years versus 0.35 years for non-CSC patients). Although CSC patients were significantly less likely to receive steroids at 6 months post-diagnosis compared to matched non-CSC patients (OR=0.72, 95%CI=0.59-0.89), they were significantly more likely to receive steroids by 2 years post-diagnosis. Prescribing patterns were similar for patients diagnosed by an ophthalmologist versus optometrist. Conclusions Despite evidence showing steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. Our results suggest a need for greater communication and collaboration among providers to ensure clinical practice reflects evidence-based recommendations.