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Effects of hydroxychloroquine therapy on choroidal volume and choroidal vascularity index

Eye (2023)Cite this article

Subjects

Abstract

Purpose

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

Methods

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.

Results

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).

Conclusion

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.

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Funding

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

Author information

Authors and Affiliations

  1. Dr. Agarwal’s Eye Hospital, Tirunelveli, Tamil Nadu, India

    Nasiq Hasan

  2. Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Matthew Driban, Kiran Kumar Vupparaboina & Jay Chhablani

  3. School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada

    Abdul Rasheed Mohammed

  4. University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Swen Schwarz & Mayss Al-Sheikh

  5. Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Shakira Yoosuf

  6. Save Sight Institute, University of Sydney, Sydney, NSW, Australia

    Daniel Barthelmes

Authors
  1. Nasiq Hasan
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  2. Matthew Driban
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  3. Abdul Rasheed Mohammed
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  4. Swen Schwarz
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  5. Shakira Yoosuf
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  6. Daniel Barthelmes
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  7. Kiran Kumar Vupparaboina
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  8. Mayss Al-Sheikh
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  9. Jay Chhablani
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Contributions

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.

Corresponding author

Correspondence to Jay Chhablani.

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Competing interests

The authors declare no competing interests.

Ethical approval

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 (2023). https://doi.org/10.1038/s41433-023-02747-x

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