We read with interest the article “Loculation of Fluid in the Posterior Choroid in Eyes With Central Serous Chorioretinopathy” by Spaide and associates. The authors describe hyporeflective areas in choroid on optical coherence tomography in patients with central serous chorioretinopathy (CSR) as posteriorly loculated fluid in a twin center study.

The results regarding subretinal fluid (SRF) were found to be inconsistent between the centers. Posterior accumulation of fluid is expected to precede the occurrence of SRF, which would manifest only after focal retinal pigment epithelium breakdown. Therefore, after the development of SRF, the posterior fluid may decrease, leading to decrease in choroidal thickness (CT). Hence, we suggest that a negative correlation between height of SRF and CT would support this hypothesis and also explain the inconsistency between SRF and posteriorly loculated fluid.

Also, as fundus angiography is the modality of choice to mark “disease activity” in CSR, active leakage should be reflected by the CT/posteriorly loculated fluid and may in fact show a stronger relation to it than SRF or pigment epithelium detachment, which have been evaluated by the authors. We suggest an analysis of fluorescein/indocyanine angiography findings for association with CT.

We keenly await the authors’ response.