A 71-year-old white man with hypertension, diabetes, myocardial infarction, and thyroid cancer was followed up for decades for bilateral, recurrent, multifocal central serous chorioretinopathy (CSCR). His visual acuity ranged from 20/15 to 20/25 bilaterally. He underwent photodynamic therapy laser treatment in the left eye in 2012 for persistent subretinal fluid, which promptly resorbed. The patient has never taken any oral medications, such as spironolactone or eplerenone, to decrease CSCR activity. Wide-field fundus color (Optos) (Figure, A) and autofluorescence (Figure, B) highlighted a “double gutter” pigmentary change in the left eye. Optical coherence tomography demonstrated bilateral pachychoroid and chronic retinal pigment epithelium changes, while optical coherence tomography angiography results did not reveal any abnormal vasculature. Peripapillary pigmentary changes consistent with CSCR were present in the right eye as well but without “guttering.” His most recent visual acuity was 20/20 OD and 20/25 OS.