Seeking clarity on retinal findings in patients with COVID-19
Authors: Elia J Duh
Journal: The Lancet (2020)

Paula M Marinho and colleagues1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar described their retinal and optical coherence tomography findings from 12 adults with recent onset of COVID-19 symptoms. Infection with severe acute respiratory syndrome coronavirus 2 has been increasingly linked to systemic damage beyond that of the respiratory system.2Gupta A Madhavan MV Sehgal K et al.Extrapulmonary manifestations of COVID-19.Nat Med. 2020; 26: 1017-1032Crossref PubMed Scopus (1967) Google Scholar Therefore, identifying additional sites affected by COVID-19 is crucial. Ocular surface abnormalities, including conjunctivitis,3Wu P Duan F Luo C et al.Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China.JAMA Ophthalmol. 2020; 138: 575-578Crossref PubMed Scopus (907) Google Scholar are well established manifestations of COVID-19. Marinho and colleagues1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar bring attention to the possibility of retinal involvement in COVID-19. As noted by the authors,1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar the observed retinal findings were subtle. Furthermore, these findings are non-specific and are not expected to have visual consequences for patients. In this Correspondence,1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar and in future reports, several important details will be crucial in facilitating scientific interpretation and allowing a fuller understanding of the possible association between COVID-19 and retinal findings. Investigators should clearly provide the overall patient sample size. Knowing the total number of adults examined by Marinho and colleagues would be helpful to gauge the prevalence of retinal abnormalities. Describing comorbidities is essential, especially hypertension and diabetes, both of which are commonly associated with the reported retinal findings of microhaemorrhages and cotton wool spots.4Grosso A Cheung N Veglio F Wong TY Similarities and differences in early retinal phenotypes in hypertension and diabetes.J Hypertens. 2011; 29: 1667-1675Crossref PubMed Scopus (43) Google Scholar Even in the absence of comorbidities, further investigation will be needed regarding the basis of the retinal findings and whether these findings reflect more than a systemic inflammatory state. It will be of great interest that future studies provide more robust retinal findings reminiscent of research on non-human coronaviruses,5Seah I Agrawal R Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals.Ocul Immunol Inflamm. 2020; 28: 391-395Crossref PubMed Scopus (465) Google Scholar in which retinal abnormalities following infection by select animal coronaviruses reflect a local retinal vasculitis and even viral infection of retinal cells. I declare no competing interests. Seeking clarity on retinal findings in patients with COVID-19Reading about Paula M Marinho and colleagues'1 retinal findings in patients with COVID-19 was very interesting. Their Correspondence was the first to report on ocular findings, other than conjunctivitis, in patients with COVID-19, and the authors suggest that these retinal findings are probably associated with COVID-19. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19 – Authors' replyWe are thankful for the comments in response to our Correspondence about retinal findings in patients with COVID-19.1 COVID-19 is a challenging new disease that has raised many questions around unusual findings. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with enthusiasm about retinal changes in patients with COVID-19 symptoms, reported by Paula M Marinho and colleagues.1 The COVID-19 pandemic is a global health emergency challenging citizens, health authorities, and scientists.2 The academic response to the pandemic has been amazing. However, many questions remain unanswered. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19Paula M Marinho and colleagues1 described hyper-reflective lesions in ganglion cell and inner plexiform layers on optical coherence tomography (OCT) images from 24 eyes of 12 adults who had symptoms of COVID-19. Marinho and colleagues argued that these lesions could be associated with COVID-19-related neurological events in humans.2 On the basis of the fundamental principles of OCT, we hold different views as to how the hyper-reflective foci were generated and their relevance to COVID-19. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with interest the Correspondence by Paula M Marinho and colleagues,1 in which they describe retinal findings in patients with COVID-19. We agree that the small cotton wool spots and retinal microhaemorrhages in a subset of these patients represent important findings showing the non-respiratory aspects of COVID-19, which are probably relevant to the neurological findings seen in some patients. Full-Text PDF Retinal findings in patients with COVID-19Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis1. Full-Text PDF