To compare optical coherence tomography angiography (OCT-A) of peripapillary total vasculature and capillaries in patients with papilledema and pseudopapilledema.

In this prospective, comparative study, forty one eyes of 21 subjects with papilledema, 27 eyes of 15 subjects with pseudopapilledema, and 48 eyes of 48 healthy normal subjects were included and were imaged using OCT-A. Peripapillary total vasculature information was recorded by using a commercial vessel density map. Customized image analysis with major vessel removal was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded.

Peripapillary vasculature values were significantly lower in papilledema (58.5±6.1%) and pseudopapilledema (58.9±4.7%) eyes compared to healthy eyes (63.2±3.1%) using commercial machine software, without a difference between papilledema and pseudopapilledema eyes. However, using our customized software, peripapillary “capillary” density of papilledema eyes was 29.8±9.4%, not significantly different from healthy subjects (31.8±7.4%) (P=0.94). Pseudopapilledema eyes with peripapillary density of 25.5±8.3% had significantly lower capillary values compared with control eyes (P=0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density in pseudopapilledemma eyes than papilledema eyes (P=0.03, P=0.02, respectively).

Whole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo disc swelling.