COVID-19 and Chloroquine/Hydroxychloroquine: is there Ophthalmological Concern?

• Published in: American journal of ophthalmology Vol. 213; pp. A3 - A4
• Main Author: Marmor, Michael F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2020; Elsevier Limited; Published by Elsevier Inc
• Subjects: Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Chloroquine - administration & dosage; Chloroquine - adverse effects; Chloroquine - therapeutic use; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Dose-Response Relationship, Drug; Humans; Hydroxychloroquine - administration & dosage; Hydroxychloroquine - adverse effects; Hydroxychloroquine - therapeutic use; Medical personnel; Ophthalmology; Pandemics; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Retina - drug effects
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2020.03.028

Some rheumatologists had been giving 1200 mg/day for 6 weeks as a loading dose when starting HCQ for SLE, and no visual loss was reported although detailed ophthalmologic exams were not performed.5,6 Two trials on treatment of myeloma and solid tumors used 1200 mg/day for 4-8 weeks, and again no visual loss was reported.7,8 The only high-dose ophthalmologic study by Leung et al followed 7 patients at 3-month intervals for 7-25 months while using 1000 mg/day of HCQ for small-cell lung cancer.9 By patient weight these doses were 3-5 times greater than the AAO recommendation. None of the others showed damage. [...]evidence to date indicates that extreme doses do accelerate retinal toxicity, but with a probable time course of many months rather than days. Ophthalmologists should judge all of this evolving information in light of well-established knowledge about dose/weight and duration as the primary determinants of retinopathy risk.11 Older literature used to cite 1000 g/day as a “toxic” dose of HCQ, but measures of absolute usage are misleading with respect to retinopathy, since toxicity relates to dose by weight.4,11 People come in all sizes, and 400 mg means something very different risk-wise to a small woman than to a large man.