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Letter to the Editor

Chloroquine, Hydroxychloroquine, Retinal Toxicity, and COVID-19

Wiwanitkit, Viroj MD∗,†,‡,§

Author Information
Asia-Pacific Journal of Ophthalmology: July-August 2020 - Volume 9 - Issue 4 - p 374
doi: 10.1097/APO.0000000000000315
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To the Editor:

The publication on “Chloroquine (CQ) and Hydroxychloroquine (HCQ) Retinal Toxicity Consideration in the Treatment of COVID-19” is very interesting. Ruamviboonsuk et al mentioned that “before prescribing CQ or HCQ, history of ocular disease should be obtained to avoid the prescription if appropriate. If either agent is to be used, routine baseline ocular examination is not absolutely necessary."1 Indeed, chloroquine is a classic drug that has been used for malaria management in tropical countries for a long time. The chance of retinal toxicity is extremely low and there is also no recommendation for ocular examination before using CQ. An important consideration on the present report is the fact that Ruamviboonsuk et al mentioned that CQ and HCQ were not proven useful for the management of COVID-19, but they recommended the use of the drugs. Using drugs without evidence of advantage is usually a big problem in the management of COVID-19 outbreak. Nevertheless, since CQ and HCQ are considered safe and well-known drug, there are more data on its safety than other new alternative therapies. Long history of CQ and HCQ use in many medical problems such as malaria systemic lupus erythrematosus might be a clue to confirm the safety to allow clinical trial of using CQ and HCQ for management of COVID-19.2 If we assure for safety, unnecessary ocular screening might not be required. Simple history-taking on ocular disease might be more appropriate and help decrease risk of ophthalmologists for unnecessary eye examination on patient with suspicious COVID-19.3

REFERENCES

1. Ruamviboonsuk P, Lai TYY, Chang A, Lai CC, Mieler WF, Lam DSC. Chloroquine and hydroxychloroquine retinal toxicity consideration in the treatment of COVID-19. Asia Pac J Ophthalmol (Phila) 2020; 9:85–87.
2. Joob B, Wiwanitkit V. SLE, hydroxychloroquine and no SLE patients with covid-19: a comment. Ann Rheum Dis 2020; 79:e61.
3. Mungmungpuntipantip R, Wiwanitkit V. Ocular manifestation, eye protection, and COVID-19. Graefes Arch Clin Exp Ophthalmol 2020; 258:1339.
Copyright © 2020 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.