Evaluation of macular sensitivity and vascular density in patients having rheumatoid arthritis on hydroxychloroquine treatment

Evaluation of macular vascular density and sensitivity using optical coherence tomography angiography (OCT-A), and 10-2 perimetry in patients having rheumatoid arthritis (RA) and receiving hydroxychloroquine (HCQ) treatment for more than 5 years in comparison to RA patients not receiving HCQ. A cross-sectional case-control study. The study included 52 eyes (52 patients) divided into 2 equal groups. Macular vascular density and sensitivity were evaluated in both groups using OCT-A and 10-2 perimetry. Field defects were significantly detected in the Lower Nasal (LN) and Upper Temporal (UT) quadrants in the HCQ group as compared to the non-HCQ group (P values=0.012 and 0.010, respectively). The vascular density decreased significantly in the Central Temporal (CT) quadrant of the superficial plexus in the HCQ group (P value 0.041). There was a significant positive correlation between vascular density and visual acuity in the CT quadrant of the deep plexus in HCQ group (P value: 0.047). In the HCQ group, the scotomata in the UT, LN, and central quadrants of the visual field were associated with significant decrease in vascular density of the corresponding LN, UT, and CT quadrants of the deep plexus respectively (P value<0.05). In the non-HCQ group, the scotomata in the LN quadrant of the visual field were associated with significant decrease in the vascular density of the corresponding UT quadrant of the deep vascular plexus. HCQ induced vascular changes are quite low and the microvascular changes in RA patients on HCQ treatment are related to the disease pathology rather than the treatment itself.