A comparative study of spectral-domain optical coherence tomography findings in papilledema and pseudopapilledema

Background: Papilledema and pseudopapilledema may present with similar clinical appearances despite distinct etiologies and management implications. Accurate differentiation is crucial to avoid unnecessary invasive investigations and delays in diagnosing raised intracranial pressure. Spectral-domain optical coherence tomography (SD-OCT) provides an objective, quantitative evaluation of optic nerve head morphology. Objective: To compare peripapillary retinal nerve fiber layer (RNFL) thickness using SD-OCT among patients with papilledema, pseudopapilledema, and healthy controls, and to assess the diagnostic accuracy of SD-OCT parameters. Materials and Methods: This analytical cross-sectional case–control study was conducted at a tertiary care center in Chennai, India, from February 2022 to February 2023. A total of 138 eyes from 81 participants were included: 41 eyes with papilledema, 20 with pseudopapilledema, and 77 age-matched control eyes. All subjects underwent comprehensive ophthalmic evaluation and standardized SD-OCT imaging. Quadrant-wise and average RNFL thickness values were analyzed using one-way analysis of variance with Tukey’s post hoc test. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results: RNFL thickness was significantly increased across all quadrants in papilledema compared with pseudopapilledema and controls ( P = 0.0005), with maximal thickening observed in the superior quadrant. Average RNFL thickness demonstrated excellent diagnostic accuracy for papilledema (AUC = 0.997), while superior quadrant RNFL thickness provided the highest discriminatory ability between papilledema and pseudopapilledema (AUC = 0.836). Conclusion: SD-OCT is a reliable, noninvasive modality for differentiating papilledema from pseudopapilledema. Peripapillary RNFL thickness, particularly average and superior quadrant measurements, represents a sensitive biomarker of true optic disc edema.