Ophthalmology AdvisorOCT-A Detects Early Retinal Changes in Long-Term Hydroxychloroquine Use

OCT-A detects parafoveal and perifoveal retinal thinning in patients on hydroxychloroquine for 5 or more years before overt toxicity develops, supporting its role as an adjunctive screening tool in a predominantly female, lupus-predominant population.

Clinical Considerations

• Parafoveal retinal thickness was significantly reduced in hydroxychloroquine users (1193 vs 1326 μm), with perifoveal thinning also present, despite no changes at the foveal center.
• Deep capillary plexus vessel density was paradoxically higher in hydroxychloroquine users, suggesting microvascular compensation or early dysregulation before structural collapse.
• OCT-A showed weak negative correlations between age and both retinal thickness and vessel density, limiting its standalone diagnostic utility.
• The study population was 88% female with a mean dose of 5.14 mg/kg, closely mirroring real-world lupus and rheumatoid arthritis patients on long-term therapy.

Practice Applications

• Add OCT-A to hydroxychloroquine monitoring protocols as an adjunct to standard OCT and visual field testing.
• Prioritize parafoveal and perifoveal thickness mapping over central foveal measurements in surveillance imaging.
• Coordinate with rheumatology colleagues to flag patients approaching or exceeding 5 years of continuous therapy for enhanced retinal screening.

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