Purpose The purpose of the study was to evaluate the role of subfoveal choroidal thickness (CT) measurements as a predictor for the course of central serous chorioretinopathy (CSC). Patients and methods Thirty-eight eyes of 33 patients with CSC were analyzed retrospectively. Key inclusion criteria were naive (acute or recurrent) CSC; a minimum of 12 months of follow up; and the availability of good quality enhanced depth imaging SD-OCT images at each visit. Eyes with changes suggestive of chronic CSC and history of any treatment were excluded. Collected data included demographic profile, visual acuity, subfoveal CT, central macular thickness (CMT), and treatment details. Univariate and multivariate analyses for association of baseline features with need for treatment were performed. On the basis of results of this analysis, the 38 eyes were divided into two groups: Group A (subfoveal CT ≤ 356 μm) and Group B (subfoveal CT4356 μm). Results On univariate analysis, the need for treatment had significantly positive correlation with duration of symptoms (P = 0.02), negative correlation with the baseline CT (Po0.01), and no significant correlation with CMT (P = 0.13). On multivariate regression analysis, only baseline CT had a statistically significant association with the need for treatment (odds ratio (OR), 0.989; CI, 0.979-0.999; P = 0.048). Group A eyes were more likely to require treatment (Group A: 54.55%, 12 of 22 eyes; Group B: 18.75%, 3 of 16 eyes; OR: 5.2, 95% CI, 1.15-23.54; P = 0.04). There was a significant decrease in subfoveal CT in Group B (−105.62 ± 108.91 μm; P = 0.002). Conclusion CSC with a subfoveal CT ≤ 356 μm is of chronic nature and is more likely to require treatment rather than observation.