Total and outer macular retinal thickness in hydroxychloroquine-treated women with rheumatoid arthritis: a descriptive cross-sectional study
Medical hypothesis, discovery & innovation in optometry,
Vol. 7 No. 3 (2026),
31 October 2026
,
Page 116-122
https://doi.org/10.51329/mehdioptometry252
Abstract
Background: Hydroxychloroquine (HCQ)-associated retinal toxicity may lead to irreversible visual loss, which highlights the importance of accurately characterizing retinal structural measurements in patients receiving long-term treatment. This study aimed to describe device-derived total retinal thickness (TRT) and outer retinal thickness (ORT) measurements obtained using spectral-domain optical coherence tomography (SD-OCT) in women with rheumatoid arthritis (RA) receiving HCQ and healthy female controls.Methods: This descriptive, exploratory cross-sectional study included 64 eye records from 32 women with RA receiving HCQ and 64 eye records from 32 healthy control women. Spectral-domain optical coherence tomography was performed using the REVO FC 130 system (Optopol Technology, Poland). TRT and ORT were summarized for the central, parafoveal, and perifoveal regions of the Early Treatment Diabetic Retinopathy Study grid. The analysis was restricted to descriptive summaries, without inferential comparisons.
Results: Mean (SD) age was 46.66 (8.90) years in the HCQ-treated RA group and 46.84 (9.13) years in the control group. The corresponding mean (SD) best-corrected visual acuity was 0.04 (0.08) and 0.02 (0.06) logMAR, respectively. In the HCQ-treated RA group, the mean (SD) treatment duration, weight-adjusted daily dose, and cumulative dose were 8.22 (6.85) years, 3.74 (0.97) mg/kg/day, and 1,006.03 (977.80) g, respectively. Mean (SD) central, parafoveal-average, and perifoveal-average TRT measurements were 230.75 (19.41), 305.46 (14.16), and 268.44 (10.11) micrometre, respectively, in the HCQ-treated RA group and 235.81 (8.15), 314.68 (6.10), and 275.14 (6.78) micrometre, respectively, in the control group. The corresponding ORT measurements were 165.48 (13.51), 148.62 (8.56), and 128.21 (5.78) micrometre in the HCQ-treated RA group and 168.42 (6.77), 155.22 (2.68), and 133.00 (4.34) micrometre in the control group.
Conclusions: In this selected cross-sectional sample, descriptive eye-record summaries showed numerically lower mean TRT and ORT measurements in HCQ-treated women with RA than in healthy controls. These observations do not establish population-level differences, HCQ-specific toxicity, selective outer-retinal involvement, temporal progression, or diagnostic biomarker performance. Interpretation is limited by fellow-eye dependence, complete overlap between HCQ exposure and RA status, and the study’s selection and measurement limitations. Future longitudinal studies incorporating an appropriate RA comparison group, accounting for fellow-eye correlation, and using independently defined toxicity outcomes are needed to determine whether ORT has value in detecting early HCQ-related retinal changes.
- hydroxychloroquine
- retinal diseases
- optical coherence tomography
- retina, cross-sectional studies
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