STUDY OF PAPILLOEDEMA & ITS CAUSATIVE FACTORS IN A TERTIARY CARE HOSPITAL

To study the etiology of papilloedema in north indian population. Our hospital based retrospective study enrolled 50 patients of papilloedema, who fullfilled our inclusion criteria. Demographic details, chief complains and detailed history was taken from all the patients. All the patients underwent blood pressure measurement by a mercury sphygmomanometer, Visual Acuity testing, Slitlamp Biomicroscopy, IOP measurement, Fundus examination. Fundus photographs were obtained using a fundus camera. Other investigations included B-scan, MRI, MRV, CT and required blood investigations were done wherever necessary. Although papilloedema occured in a vast variety of age group but maximum patients (32%) were from the age group of >18-31 years and males (64%) were more affected than females according to our study. 66% of the patients had good vision with papilloedema. In our study all the patients had bilateral papilloedema and 54% of patients were diagnosed with early papilloedema. Idiopathic Intracranial Hypertension was the main etiology for papilloedema. In this study we concluded IIH (a diagnosis of exclusion) as the most common underlying etiology for papilloedema

Study on the sequence of morphological and angiographic changes due to intraocular pressure elevation in the optic nerve head / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To figure out the sequence of vessel density(VD)changes in the retina and deformation induced by mechanical force in the optic nerve head(ONH)tissue during intraocular pressure(IOP)elevation.<p>METHODS: This prospective study tested 34 eyes from 34 healthy volunteers. Group A had 23 subjects. Their testing protocol included a baseline phase, two elevated IOP phases(15 mmHg and 30 mmHg respectively for 2min), and a recovery phase. Group B had 11 subjects, and their protocol included an IOP elevation of 15 mmHg for 10min. In each phase the deformation in the ONH and macular region were scanned by optical coherence tomography(OCT), and Bruch's membrane opening(BMO)distance, the optic nerve head surface depth(ONHSD), the subfoveal choroidal thickness(SFCT)were measured, the VD was measured by OCTA.<p>RESULTS: After the first IOP elevation in group A, the VD in the ONH decreased(superficial capillary plexuses, from 67.39±7.65% to 43.78±5.89%, <i>P</i><0.05), the BMO distance, the ONHSD, the VD in the macula and the SFCT did not change. After the second IOP elevation, the VD in the ONH and in the macular region both decreased, the BMO distance and ONHSD increased(all <i>P</i><0.05). After the IOP elevation in group B, the VD in the ONH and in the macular region decreased significantly, the BMO distance increased, the SFCT did not change. ONH VD reduction is not associated with BMO distance increment(<i>r</i>=0.050, <i>P</i>>0.05).<p>CONCLUSION:The ONH tissue is more sensitive to hemodynamics than to morphological change. Hemodynamics during IOP elevation differs in the ONH and the macular tissue.

Comparative study of retinal nerve fibre layer thickness in normal and glaucomatous human eyes as measured by optical coherence tomography

Background: Glaucoma is a disease primarily associated with damage to the Retinal Ganglion Cell (RGC) bodies and axons, which causes characteristic patterns of Visual Field (VF) and changes in the appearance of the Optic Nerve Head (ONH). This Study Compares Nerve Fibre layer thickness in normal and Glaucomatous Human Eye.Methods: It is a case control observational study carried out in 100 patients in a tertiary eye care hospital in the department of ophthalmology in the period from 1st January 2019 to 30th June 2019.Results: The diagnostic ability for distinguishing between normal and glaucoma patients were same when authors consider average RNFL thickness and average GCC thickness. Diagnostic accuracy increases when authors consider both RNFL and GCC thickness. There was a significant difference in both RNFL and GCC thickness between normal and glaucoma patient (p<0.001). The mean deviation shows a significant correlation with all the parameters in eyes with glaucoma (<0.001).Conclusions: RNFL thickness as measured by OCT showed statistically significant correlation with glaucoma. RNFL seems to have higher sensitivity and specificity for the detection of early glaucoma. Diagnostic accuracy increases when we include other parameters like RNFL and visual fields.

Safety of photodynamic therapy involving optic nerve head

We present a case of large peripapillary polypoidal choroidal vasculopathy treated with standard-fluence photodynamic therapy (PDT) as other treatment options were unsuccessful or not justified. Due to large lesion size, treatment spot included part of optic disc also. PDT resulted in regression of polyp and visual improvement (from 20/300 to 20/20) without any collateral damage to optic nerve as evidenced by visual-field test and visual-evoked potential with a follow-up till 2 years. This case highlights the role of PDT as a safe alternative for treatment of large peripapillary lesion, even though the treatment spot encompasses part of the optic nerve head.

Clinical, ultrasonographic and optical coherence tomography correlation of optic nerve head cupping in glaucoma patients

Purpose: To ascertain if ultrasound (USG) B-scan examination of the optic nerve head (ONH) can be a useful tool to diagnose and quantify glaucomatous cupping. Methods: A cross-sectional observational study of 48 eyes of 48 patients with clear ocular media and cup-disc ratio of (CDR) ?0.6 were included. The disc was studied by + 90D examination, USG B-scan and ONH Optical coherence tomography (OCT) by three masked observers. Observer-1 assessed the clinical CDR, observer-2recordedopticcup diameter on USG B-scan and observer-3performed ONH OCT to note the software computed average CDR. Measurements of cupping obtained by these 3 methods were compared and their relative strengths determined. The interdependency between variables was further studied using regression analysis. Results: Clinically assessed disc ratios of 0.6, 0.7, 0.8, 0.9, and total corresponded to USG cup measures of 1.02 ± 0.11 mm, 1.23 ± 0.14 mm, 1.35 ± 0.072 mm, 1.45 ± 0.084 mm, 1.75 ± 0.15 mm and OCT average CDR of 0.62 ± 0.087, 0.68 ± 0.060, 0.75 ± 0.078, 0.81 ± 0.036, 0.89 ± 0.038, respectively. There was an excellent correlation between the three arms, with Pearson's co-efficient (r) of 0.87, P < 0.001 between clinical and USG cupping; r = 0.89, P < 0.001 between clinical and OCT cupping; and r = 0.88, P < 0.001 between USG and OCT cupping. A relation of y = 1.64x + 0.03 was obtained between them, where y stands for USG cup diameter and x stands for the observed clinical CDR. Conclusion: Ultrasonographic measurement of optic cup diameter corresponds well to clinical ONH cupping. Therefore, it can reliably be used in quantifying ONH cupping in cases of media opacities which preclude optic disc visualization.

Clinical validation of RIA-G, an automated optic nerve head analysis software

Purpose: To clinically validate a new automated glaucoma diagnosis software RIA-G. Methods: A double-blinded study was conducted where 229 valid random fundus images were evaluated independently by RIA-G and three expert ophthalmologists. Optic nerve head parameters [vertical and horizontal cup–disc ratio (CDR) and neuroretinal rim (NRR) changes] were quantified. Disc damage likelihood scale (DDLS) staging and presence of glaucoma were noted. The software output was compared with consensus values of ophthalmologists. Results: Mean difference between the vertical CDR output by RIA-G and the ophthalmologists was ? 0.004 ± 0.1. Good agreement and strong correlation existed between the two [interclass correlation coefficient (ICC) 0.79; r = 0.77, P < 0.005]. Mean difference for horizontal CDR was ? 0.07 ± 0.13 with a moderate to strong agreement and correlation (ICC 0.48; r = 0.61, P < 0.05). Experts and RIA-G found a violation of the inferior–superior NRR in 47 and 54 images, respectively (Cohen's kappa = 0.56 ± 0.07). RIA-G accurately detected DDLS in 66.2% cases, while in 93.8% cases, output was within ± 1 stage (ICC 0.51). Sensitivity and specificity of RIA-G to diagnose glaucomatous neuropathy were 82.3% and 91.8%, respectively. Overall agreement between RIA-G and experts for glaucoma diagnosis was good (Cohen's kappa = 0.62 ± 0.07). Overall accuracy of RIA-G to detect glaucomatous neuropathy was 90.3%. A detection error rate of 5% was noted. Conclusion: RIA-G showed good agreement with the experts and proved to be a reliable software for detecting glaucomatous optic neuropathy. The ability to quantify optic nerve head parameters from simple fundus photographs will prove particularly useful in glaucoma screening, where no direct patient–doctor contact is established.

Effect of Honey Cocktail on Macular Thickness, Retinal Nerve Fiber Layer Thickness and Optic Nerve Head Parameters in Post-Menopausal Women

@#Introduction: Honey postulated may have an estrogenic effect on the retinal estrogenic receptors. The aim of the study is to compare the mean macular thickness, retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters with and without honey cocktail supplement in post-menopausal women. Methods: A randomised interventional study was conducted from March 2014 to July 2015. A total of 60 post-menopausal women were selected and randomised into 2 groups: honey cocktail (20 mg/day) and control. Macular thickness, RNFL thickness and ONH parameters were measured using optical coherence tomography at baseline and at 3 months post honey cocktail supplementation. Results: The mean global macular thickness and RNFL thickness were significantly thicker in post-menopausal women with honey cocktail at 3 months post supplement (p = 0.002 and 0.033 respectively). There was a significant increase in the mean change of global macular thickness and RNFL thickness in honey cocktail group at 3 months post supplement (p < 0.001 and < 0.001 respectively). Although there was no significant difference in the ONH parameters at 3 months post supplement between the two groups but there was significant increase in the mean change of rim area (p = 0.003), and significant reduce in the mean change of cup area (p = 0.001) and cup-disc-ratio (p <0.001) in honey cocktail group at 3 months post supplement. Conclusion: Honey cocktail supplement showed structural changes in the macular thickness, RNFL thickness and OHN parameters of post-menopausal women.

Assessment of retinal nerve fiber layer thickness in migraine patients measured with optical coherence tomography

Background: Headache is one of the most disturbing symptoms with common neurological signs. Variations in optic nerve perfusion quality or retinal microcirculation may end up in peripapillary retinal nerve fiber layer (RNFL) thickness in patients with migraine. The aim of this study was to investigate the retinal nerve fiber layer (RNFL) thickness in patients with migraine.Methods: This cross-sectional study was conducted by including thirty patients diagnosed with migraine and thirty normal individuals. Patients were evaluated in groups including migraine with and without aura and controls. Retinal nerve fiber layer (RNFL) thickness was measured using stratus optical coherence tomography (OCT) and then was compared in case and control groups. All data were analyzed using SPSS software version 16.Results: RNFL thickness was significantly thinner in migraine patients compared to the control group. Symmetricity of RNFL showed significantly reduction in patients with migraine compared to standard value (95% vs 68%). Comparison of NRR area between patients and standard value showed significantly reduced values (P=0.0001). Mean value of optic disc area showed significantly reduced value compared to standard value about 2.35 m2 (P=0.0001).Conclusions: This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms.

A Case of Optic Nerve Head Swelling in a Patient with Primary Open-angle Glaucoma

PURPOSE: To report a case of masked glaucomatous optic nerve head damage due to acute swelling in a primary open-angle glaucoma patient. CASE SUMMARY: A healthy 21-year-old male visited our clinic complaining of blurred vision in the right eye for 1 week. The intraocular pressure (IOP) was 60 mmHg, as measured by a Goldmann applanation tonometer. No specific anterior segment finding other than severe corneal edema was found on slit lamp examination. Maximum tolerated medical therapy was performed, and a further examination was done 1 day after the IOP lowering. No glaucomatous change in the optic disc or retinal nerve fiber layer was observed on fundus examination and optical coherence tomography (OCT), but the optic disc of the right eye was more hyperemic than that of the left eye. A superonasal visual field defect was also observed using automated perimetry. After treatment, the IOP was kept within the normal range using IOP-lowering eye drops. However, an inferonasal retinal nerve fiber layer defect was observed on fundus examination and OCT, and a superonasal scotoma was detected by perimetry.

Retinal Nerve Fiber Layer and Macular Ganglion Cell Thicknesses in Situs Inversus of Optic Discs

PURPOSE: To investigate circumpapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses as measured by optical coherence tomography in eyes with situs inversus of optic discs. METHODS: RNFL and macular GCIPL thicknesses were measured in eyes with situs inversus of optic discs without other ocular abnormalities (situs inversus group) and in age- and refractive error-matched healthy eyes (control group). RNFL thickness (global area, superior, nasal, inferior, and temporal quadrants) and GCIPL thickness (global area, superior-temporal, superior, superior-nasal, inferior-nasal, inferior, and inferior-temporal sectors and minimum) were compared between the groups. RESULTS: Nine eyes of 5 subjects with situs inversus of optic discs and 20 healthy eyes of 20 subjects (10 eyes for control groups A and B, respectively) were enrolled. No significant difference was found in superior or inferior quadrant RNFL thickness (p > 0.05); however, the situs inversus group showed a thicker RNFL in the nasal quadrant and a thinner RNFL in the temporal quadrant (p < 0.01). In macular GCIPL thickness, no significant difference was found in the superotemporal or inferiotemporal sector or for minimum thickness (p < 0.05); however, the situs inversus group showed thicker GCIPL in the global area, superior, superonasal, inferonasal, and inferior sectors than the control groups (p < 0.01). CONCLUSIONS: In eyes with situs inversus of optic discs, distribution of circumpapillary RNFL and macular GCIPL thickness were different from eyes without this condition. When assessing RNFL and macular GCIPL thicknesses in eyes with situs inversus of optic discs, caution is needed.

Tamaño del nervio óptico detectado por tomografía coherencia óptica en pacientes sanos atendidos en un centro oftalmológico del Paraguay / Size of the optic nerve detected by optic coherencetomography in healthy patients in an ophthalmologicalcenter of Paraguay

El objetivo de este trabajo fue determinar el tamaño del disco óptico por tomografía de coherencia óptica (TCO), en una población mayor de 40 años, que asistió a control rutinario oftalmológico desde noviembre el 2015 a febrero del 2016 y que no tenían antecedentes conocidos de glaucoma ni de enfermedades sistémicas. Fueron incluidos en el estudio 52 pacientes que asistieron a la consulta externa de oftalmología de la Fundación Visión, por un examen de rutina. Se le diligenció una historia clínica completa, donde se indagaron los antecedentes patológicos tanto sistémicos como oculares. Se realizó la toma de la agudeza visual utilizando la cartilla de Snellen en cada ojo por separado a 6 metros del paciente, refracción automatizada, prueba refractiva, biomicroscopía en lámpara de hendidura con énfasis en la profundidad de la cámara anterior. Se excluyeron pacientes con cámaras anteriores pandas o estrechas (utilización de gonioscopio mirrow 4 mini) y presión intraocular elevada. Luego de la instilación de Tropicamida 0,5%/Fenilefrina HCL 5% en cada ojo y evaluación del polo posterior en lámpara de hendidura con lente de 90D Superfield, se realizó la Tomografía de coherencia óptica con el equipo The ZEISS Cirrus(tm) HD-TCO Model 4000 (Cirrus HD-TCO).

The objective of this study was to determine the size of the optic nerve by opticalcoherence tomography (TCO) in a population older than 40 years old who attendedroutine ophthalmological control from November 2015 to February 2016 and did not haveknown records of glaucoma or systemic. Fifty two patients were included in the study whoatended the external consulting room of ophthalmology of the Foundation Vision for aroutine control. A full medical history was completed, where the systemic and ocularpathologic records were investigated. Visual acuity test was performed using Snellen chartin each patient separately at 6 meters from the patinet. Automatic refraction, retractiontest, slit lamp biomicroscopy with emphasis in the anterior chamber depth were alsoperformed. Patients with narrow or panda anterior chambers (using the mini 4 mirrorgonioscope and high intraocular pressure were excluded. After instillation of tropicamide0.5%/phenylephrine HCL 5% in each eye and evaluation of the posterior pole in slit lampwith 90D Superfield lens, the optic coherence tomography was made using a ZEISSCirrus™ HD-TCO Model 4000 (Cirrus HD-TCO).

Maculopatía relacionada con la foseta del nervio óptico / Optic nerve head pit-associated maculopathy

Se realizó una revisión bibliográfica con el objetivo de ampliar el conocimiento sobre la maculopatía relacionada con la foseta del nervio óptico, su fisiopatología, así como sus principales manifestaciones, diagnóstico clínico, angiográfico y por tomografía de coherencia óptica, y describir algunos de los tratamientos que se han utilizado recientemente a nivel mundial. Se tuvieron en cuenta las tendencias actuales de tratamiento. Se consultaron fundamentalmente artículos científicos de revistas publicados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema en los últimos 5 años, a través de Google como motor de búsqueda. A pesar de que se trata de una enfermedad infrecuente, su manejo suele resultar difícil, especialmente cuando existe afectación macular. En nuestro trabajo constatamos que la mayoría de los estudios utilizan muestras pequeñas, son retrospectivos, no comparativos y no ramdomizados. Sin embargo, se encontraron modalidades de tratamiento que han sido utilizadas por años y más recientemente descripciones de nuevas técnicas que requerirán futuros estudios. No existe un consenso sobre un protocolo ideal de tratamiento para esta entidad(AU)

A literature review was made to expand knowledge on the optic nerve head pit-related maculopathy, its physiopathology and main manifestations, clinical and angiographic diagnosis, optical coherence tomography, and to describe some of the treatments recently used worldwide. The current therapeutic tendencies were taken into account. The fundamental sources of information were scientific articles from journals in PubMED and Cochrane databases as well as basic texts which dealt with this topic in the last five years through Google search engine. Despite the rare occurrence of the disease, its management may be difficult particularly in macular effect cases. This paper confirmed that most of the studies used small samples, were retrospective, non-comparative and non-randomized. However, some therapeutic modalities were found, which have been used for years and also descriptions of new techniques that require further research. There is no consensus on the ideal treatment protocol for this disease(AU)

Optic nerve head parameters of high‑definition optical coherence tomography and Heidelberg retina tomogram in perimetric and preperimetric glaucoma.

Background: Heidelberg retina tomogram (HRT) and optical coherence tomography (OCT) are two widely used imaging modalities to evaluate the optic nerve head (ONH) in glaucoma. Purpose: To compare the ONH parameters of HRT3 and high‑definition OCT (HD‑OCT) and evaluate their diagnostic abilities in perimetric and preperimetric glaucoma. Design: Cross‑sectional analysis. Methods: 35 control eyes (24 subjects), 21 preperimetric glaucoma eyes (15 patients), and 64 perimetric glaucoma eyes (44 patients) from the Longitudinal Glaucoma Evaluation Study underwent HRT3 and HD‑OCT examinations. Statistical Analysis: Agreement between the ONH parameters of HRT and HD‑OCT were assessed using Bland–Altman plots. Diagnostic abilities of ONH parameters were evaluated using area under the receiver operating characteristic curves (AUCs), sensitivity at fixed specificity, and likelihood ratios (LR). Results: Optic disc area, vertical cup to disc ratio, and cup volume with HD‑OCT were larger than with HRT, while the rim area was smaller with HD‑OCT (P < 0.001 for all comparisons). AUCs of all HD‑OCT ONH parameters (0.90–0.97 in perimetric and 0.62–0.71 in preperimetric glaucoma) were comparable (P > 0.10) to the corresponding HRT ONH parameters (0.81–0.95 in perimetric and 0.55–0.72 in preperimetric glaucoma). LRs associated with diagnostic categorization of ONH parameters of both HD‑OCT and HRT were associated with larger effects on posttest probability of perimetric compared to preperimetric glaucoma. Conclusions: ONH measurements of HD‑OCT and HRT3 cannot be used interchangeably. Though the diagnostic abilities of ONH parameters of HD‑OCT and HRT in glaucoma were comparable, the same were significantly lower in preperimetric compared to perimetric glaucoma.

Study on ageing changes of the optic nerve head in a group of normal subjects.

Introduction: Thickness of RNFL around the different quadrants of the optic disc margin progressively increases. Macular fibers occupying the lateral quadrant are the most resistant to glaucomatous damage and explain the retention of the central vision till end. This study was undertaken to determine the age related changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in a group of normal subjects. Material and Methods: This prospective cross sectional hospital based study consisted of 150 healthy eyes of 75 subjects whom underwent ONH measurement using the Optovue optical coherence tomography (OCT) and examined the result of optic nerve head parameters and RNFL. Results- Mean cup disc ratio was found to be higher with increasing age. And the average RNFL thickness was found to decrease with increasing age. Conclusion: There are changes in optic disc parameters and RNFL with increasing age and the changes were measurable and significant.

The Analysis of Retinal Nerve Fiber Layer in Amblyopia Using Spectral Domain Optical Coherence Tomography

PURPOSE: To determine whether retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters differ in the amblyopic and normal fellow eyes of hyperopic anisometropic amblyopic patients using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 30 patients with hyperopic anisometropic amblyopia; patient eyes were divided into 30 anisometropic amblyopic eyes and 30 normal fellow eyes. RNFL thickness, disc area, rim area, average cup-to-disc ratio, and cup volume were obtained using SD-OCT. Axial length was obtained using the IOL Master®, and the interocular differences between group were analyzed. RESULTS: Nasal quadrant RNFL thickness of amblyopic eyes was significantly thicker than that of normal fellow eyes in amblyopic patients (p = 0.010). Among optic nerve parameters, cup volume of amblyopic eyes was significantly smaller than that of normal fellow eyes (p = 0.021). No significant relationship between refractive error and RNFL thickness was observed, and a significant positive linear relationship was observed between neural rim area and RNFL thickness (rho = 0.426, p = 0.005). CONCLUSIONS: SD-OCT analysis of hyperopic anisometropic amblyopic eyes demonstrated a significant increase in nasal RNFL thickness compared to fellow non-amblyopic eyes. No optic nerve head parameters except cup volume showed significant change.

Optical Coherence Tomography Findings of Optic Nerve Head Drusen in Children and Adolescents

PURPOSE: To analyze the features of optic nerve head drusen (ONHD) observed on the optical coherence tomography (OCT) of pediatric and adolescent patients and to compare the characteristics of diagnosed ONHD pediatric and adolescent patients with the control group. METHODS: We performed a retrospective chart review of pediatric and adolescent patients with nasal elevation or marginal blurring of the optic nerve head on either direct ophthalmoscopic examination or fundus photography. Patients were compared with a control group of the same age who had normal optic nerve heads and no abnormal findings except refractive errors under ophthalmic examination including OCT. RESULTS: There were 29 eyes (n = 16) with ONHD as a subretinal mass-like lesion on OCT among 84 eyes with nasal elevation or marginal blurring of the optic nerve head on OCT. Thirteen patients (18.8%) were diagnosed with ONHD in both eyes. The following 3 groups were compared: group 1, showing nasal elevation or marginal blurring of the optic nerve head on OCT and diagnosed with ONHD; group 2, without ONHD; group 3, normal controls. The spherical equivalent was significantly different among the groups (p < 0.001). Compared with group 3, group 1 showed peripapillary retinal nerve fiber layer thickening of the temporal area; however, there was no difference between groups 1 and 2. CONCLUSIONS: Buried ONHD in children and adolescents may be asymptomatic and the diagnosis can be made when a subretinal mass-like lesion is detected on OCT.

Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen.

Aim: To compare the spectral domain optical coherence tomography (SD-OCT) findings of the optic disc and the peripapillary retina of patients with a true papilledema and pseudopapilledema with and without optic nerve head drusen (ONHD). Study Design: Retrospective Case Control Study. Subjects and Methods: Peripapillary retinal nerve fiber layer (PPRNFL) thickness as depicted by SD-OCT of 94 eyes of 66 patients with papilledema (30 eyes), pseudopapiledema (31 eyes), and normal controls (33 eyes) was analyzed. The mean RNFL thickness, total retinal thickness (TRT) at a superior and inferior edge of the disc and the quadrant wise topography of increased RNFL were compared in all three groups. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) were calculated for all the parameters. Results: The median RNFL thickness was 185.4 (129.5–349.3 μm), 122.3 (109–156.3 μm) and 91.62 ± 7 μm in papilledema, pseudopapilledema, and controls, respectively. Papilledema group had thicker PPRNFL in all quadrants except temporal quadrant. TRT was thicker in papilledema and pseudopapilledema compared to controls. ONHD could be directly visualized as high reflective clumps in the sub-retinal space or the RNFL in 30 eyes. Increased RNFL thickness in all four quadrants was noted 43.3% in papilledema and 9.7% in pseudopapilledema. Normal RNFL thickness in all four quadrants was noted in 0% in papilledema and 32.3% in pseudopapilledema. Nasal RNFL had the highest AROC (0.792) indicating high diagnostic ability to differentiate papilledema from pseudopapilledema. Conclusion: SD-OCT can be used as a tool to differentiate between papilledema and pseudopapilledema.