Objective To observe the features of the foveal photoreceptor layer in eyes with central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (Spectralis OCT); to analyze the relationship between best corrected visual acuity (BCVA), the morphology of the outer segments (OS) and the thickness of the outer nuclear layer. Methods This was a prospective case control study. The morphology of the outer segments was observed and central thickness of outer nuclear layer (CTONL) at the central fovea was measured in 24 consecutive CSC eyes of 23 patients and 18 normal control eyes of 18 normal people on Spectralis OCT images. The eyes of CSC patients were divided into two groups based on the morphology of the outer segment: the preserved outer segement group and the atrophy group. The correlation between BCVA and CTONL in these groups was evaluated separately. An independent samples t test was used to compare CTONL and the average BCVA of the goups. A Pearson correlation test was used for the correlation between CTONL and BCVA in the CSC patient group. A Spearman rank correlation test was used for the correlation between symptom duration and CTONL in the CSC patient group. Results The outer segment band of the serous detached fovea was preserved well in 17 eyes (71%), and atrophic in 7 eyes (29%). The average CTONL was (73.6±19.6) μm in the CSC group, which was significantly less than that [(114.8±15.6)μm] in the normal group (t=7.274, P<0.01). The average CTONL was (53.0±14.1)μm in the atrophic subgroup, which was significantly thinner than that [(82.1±14.6)μm] in the preserved group (t =4.482, P<0.01). The BCVA was 4.86±0.14 in the atrophic group, which was significantly less than that (4.50±0.26) in the preserved group (t=4.294, P<0.01). BCVA was positively correlated with CTONL (r=0.918, P<0.01). The course of the disease was negatively correlated with CTONL and BCVA (r=-0.994,-0.989, P<0.01 for both). Conclusion BCVA is correlated with CTONL and the health of the outer segment, the BCVA of the preserved group is better than that of the atrophic group; the thinner the CTONL is, the worse the BCVA.