Background: Hydroxychloroquine (HCQ) was widely used in the treatment of rheumatoid arthritis. HCQ retinopathy, is a well-documented side effect of HCQ which could be investigated by Optical coherence tomography angiography (OCTA).

Purpose: to detect retinal alterations in Rheumatoid arthritis patients taking hydroxychloroquine (HCQ) by OCTA and compare them with a control group.

Patients and methods: This prospective cross-sectional study included a total of 80 eyes, 40 eyes of rheumatoid arthritis (RA) patients taking HCQ and 40 eyes of normal healthy individuals with completely normal ophthalmological examination. The patients were further divided into high risk and low risk retinopathy groups according to duration of HCQ use. OCTA imaging was performed via Angiovue software.

Results: The patients' superior hemi, inferior hemi, and peri-fovea all showed noticeably decreased deep vascular density. (p < 0.05) . No significant differences were observed regarding vascular density in the fovea and para fovea. High risk patients demonstrated significantly lower superficial vascular density in whole image, superior hemi, para-fovea, and peri-fovea and also significantly lower deep vascular density in superior hemi and para fovea (p < 0.05). Duration of drug use showed significant negative correlations with superficial vascular density in whole image, superior hemi, para fovea and peri fovea also with deep vascular density in whole image, superior hemi, and peri fovea (p < 0.05).

Conclusion: OCTA could be a tool of value to detect retinal alterations in RA patients taking HCQ at the level of deep vascular density parameters in all patients and in superficial and deep vascular density in high-risk patients.