Seeking clarity on retinal findings in patients with COVID-19
Authors: Frederick T Collison, Joseph Carroll
Journal: The Lancet (2020)

We read with interest the Correspondence by Paula M Marinho and colleagues,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 (377) Google Scholar 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. The authors also report hyper-reflective features in the inner retina on optical coherence tomography (OCT) images from all 12 patients.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 (377) Google Scholar The OCT findings appear to take three forms: (1) pairs of thin, parallel, hyper-reflective bands; (2) thicker, horizontally oriented, hyper-reflective bands occupying nearly the entire thickness of the ganglion cell layer; and (3) moderately hyper-reflective foci. We reviewed our database of OCT images acquired between 2009 and 2019 (before the COVID-19 pandemic) from more than 400 individuals with normal vision. We identified these same inner retinal features in every individual, which is inconsistent with the supposed pathological origin (appendix). Blood vessels appear as hyper-reflective structures in the inner retina and are accompanied by a hyporeflective, vertical tail (shadow) through the retina (appendix).2Cense B Nassif N Chen T et al.Ultrahigh-resolution high-speed retinal imaging using spectral-domain optical coherence tomography.Opt Express. 2004; 12: 2435-2447Crossref PubMed Scopus (446) Google Scholar The variable appearance of the hyper-reflective signal is due to the varying angle at which the OCT scan intersects the blood vessel, with orthogonal sectioning resulting in the smallest profile. A finding present in a large proportion of patients with COVID-19 would be of great potential diagnostic value. However, many, if not all, of the OCT findings reported by 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 (377) Google Scholar represent normal retinal anatomy. We declare no competing interests. This Correspondence was supported in part by the National Eye Institute of the National Institutes of Health under award number R01EY017607. The content of this Correspondence is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Download .pdf (.96 MB) Help with pdf files Supplementary appendix 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-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-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-19Paula M Marinho and colleagues1 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.2 Therefore, identifying additional sites affected by COVID-19 is crucial. Ocular surface abnormalities, including conjunctivitis,3 are well established manifestations of COVID-19. Marinho and colleagues1 bring attention to the possibility of retinal involvement in COVID-19. 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