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Effects of hydroxychloroquine therapy on choroidal volume and choroidal vascularity index



To determine changes in choroidal volume (CV) and choroidal vascularity index (CVI) in patients on hydroxychloroquine (HCQ) therapy.


Retrospective analysis of patients on HCQ therapy. CV and CVI were assessed below the central foveal region on spectral-domain optical coherence tomography using an automatic denoising and localization algorithm. CV and CVI were compared with age-matched controls. Regression analyses were performed to generate associations between CV and CVI with demographics and HCQ treatment parameters. Associations were assessed using a generalized estimating equation model adjusted for intra-subject inter-eye correlations.


A total of 137 adult patients (23 males and 114 females) were included. Mean age was 45.6 ± 13.7 years and most patients identified as Caucasian (79%). Total duration of HCQ therapy ranged from 3 months to 20 years. Daily HCQ intake varied from 150–600 mg (mean = 304 mg), while cumulative doses ranged from 18–2,800 g. At presentation, the median CV was 0.51 (IQR:0.356–0.747) mm, and median CVI was 0.559 (IQR:0.528–0.578). Increased cumulative HCQ dose was associated with decreased CV (p = 0.006). Compared to age-matched controls, CV, CVI, and luminal area were significantly lower in the study group (p = 0.0003, 0.0001, and 0.0002).


In this study, we present a novel analysis of key biomarkers which predate the occurrence of HCQ retinopathy. Choroidal volume and vascularity index are significantly reduced in patients on HCQ therapy, especially at higher cumulative doses. These findings suggest new tools to guide medical decision-making for patients receiving HCQ therapy for rheumatologic diseases.

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Fig. 1: Choroidal volume and vascularity of study eyes and age-matched controls.
Fig. 2: Correlation between cumulative dose and choroidal volume.

Data availability

Data are available upon request.


  1. Schrezenmeier E, Dörner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol. 2020;16:155–66.

    Article  CAS  PubMed  Google Scholar 

  2. Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye. 2017;31:828–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF, American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118:415–22.

    Article  PubMed  Google Scholar 

  4. Marmor MF, Hu J. Effect of disease stage on progression of hydroxychloroquine retinopathy. JAMA Ophthalmol. 2014;132:1105–12.

    Article  PubMed  Google Scholar 

  5. Min CH, Lee JY, Yoon YH. Longitudinal changes in outer nuclear layer and choroidal thickness in patients using hydroxychloroquine before development of retinopathy. Investig Ophthalmol Vis Sci. 2022;63:3786.

    Google Scholar 

  6. Polat OA, Okçu M, Yılmaz M. Hydroxychloroquine treatment alters retinal layers and choroid without apparent toxicity in optical coherence tomography. Photodiagnosis Photodyn Ther. 2022;38:102806.

    Article  CAS  PubMed  Google Scholar 

  7. Cinar E, Yuce B, Aslan F. Evaluation of retinal and choroidal microvascular changes in patients who received hydroxychloroquine by optical coherence tomography angiography. Arq Bras Oftalmol. 2021;84:2–10.

    PubMed  Google Scholar 

  8. Forte R, Haulani H, Dyrda A, Jürgens I. Swept source optical coherence tomography angiography in patients treated with hydroxychloroquine: correlation with morphological and functional tests. Br J Ophthalmol. 2021;105:1297–301.

    Article  PubMed  Google Scholar 

  9. Ahn SJ, Ryu SJ, Joung JY, Lee BR. Choroidal thinning associated with hydroxychloroquine retinopathy. Am J Ophthalmol. 2017;183:56–64.

    Article  PubMed  Google Scholar 

  10. Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol. 2019;64:312–33.

    Article  PubMed  Google Scholar 

  11. Iovino C, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Govetto A, et al. Choroidal vascularity index: an in-depth analysis of this novel optical coherence tomography parameter. J Clin Med. 2020;9:595.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Agrawal R, Chhablani J, Tan KA, Shah S, Sarvaiya C, Banker A. Choroidal vascularity index in central serous chorioretinopathy. Retina. 2016;36:1646–51.

    Article  PubMed  Google Scholar 

  13. StataCorp LP. Stata statistical software: release 16. College Station, TX. 2019.

  14. Rainsford KD, Parke AL, Clifford-Rashotte M, Kean WF. Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis, and related diseases. Inflammopharmacology. 2015;23:231–69.

    Article  CAS  PubMed  Google Scholar 

  15. Dardenne MU, Nordmann J. Biochemistry of the Eye: Symposium at Tutzing Castle, August 10-13, 1966. Munich: Karger; 1968.

  16. Ahn SJ, Ryu SJ, Lim HW, Lee BR. Toxic effects of hydroxychloroquine on the choroid: evidence from multimodal imaging. Retina. 2019;39:1016–26.

    Article  CAS  PubMed  Google Scholar 

  17. Bulut M, Akıdan M, Gözkaya O, Erol MK, Cengiz A, Çay HF. Optical coherence tomography angiography for screening of hydroxychloroquine-induced retinal alterations. Graefes Arch Clin Exp Ophthalmol. 2018;256:2075–81.

    Article  CAS  PubMed  Google Scholar 

  18. Iqbal M, Wong WT, Chew EY, Cukras CA. Comparison of choroidal and retinal thicknesses in patients with and without hydroxychloroquine toxicity. Investig Ophthalmol Vis Sci. 2019;60:5715.

    Google Scholar 

  19. Yılmaz H, Akıncıoğlu D, Kucukevcilioglu M, Özge G, Durukan A, Mutlu F. Choroidal thickness in patients using hydroxychloroquine without retinal toxicity. Hitit Med J. 2020;2:73–8.

  20. Karti O, Ayhan Z, Zengin MO, Kaya M, Kusbeci T. Choroidal thickness changes in rheumatoid arthritis and the effects of short-term hydroxychloroquine treatment. Ocul Immunol Inflamm. 2018;26:770–5.

    Article  CAS  PubMed  Google Scholar 

  21. Duru N, Altinkaynak H, Erten Ş, Can ME, Duru Z, Uğurlu FG, et al. Thinning of choroidal thickness in patients with rheumatoid arthritis unrelated to disease activity. Ocul Immunol Inflamm. 2016;24:246–53.

    Article  CAS  PubMed  Google Scholar 

  22. Ferreira CS, Beato J, Falcão MS, Brandão E, Falcão-Reis F, Carneiro ÂM. Choroidal thickness in multisystemic autoimmune diseases without ophthalmologic manifestations. Retina. 2017;37:529–35.

    Article  PubMed  Google Scholar 

  23. Braga J, Rothwell R, Oliveira M, Rodrigues D, Fonseca S, Varandas R, et al. Choroid thickness profile in patients with lupus nephritis. Lupus. 2019;28:475–82.

    Article  CAS  PubMed  Google Scholar 

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MA-S: protected research time granted by the University of Zurich,234 Career development program filling the gap.

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Authors and Affiliations



All authors contributed to the study conception and design. Image analysis: MD/ARM. Data analysis: NH. Writing—original draft preparation: NH/MD. Writing—review and editing: MD/JC/MA-S/DB.

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Correspondence to Jay Chhablani.

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The authors declare no competing interests.

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Study approved by the Institutional review board of Swiss ethics/BASEC 240 (No. 2019-00972).

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Hasan, N., Driban, M., Mohammed, A.R. et al. Effects of hydroxychloroquine therapy on choroidal volume and choroidal vascularity index. Eye 38, 620–624 (2024).

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