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Cohort studyGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026

Diagnostic performance of optical coherence tomography-derived structural parameters in differentiating pediatric papilledema from pseudopapilledema.

Elie Zaher, Nemer Sayed Ahmad, Siraa Hilf … Nitsan Duvdevan-Strier

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OphthalmologyCohort study

Retinal nerve fiber layer thickness on optical coherence tomography accurately distinguishes papilledema from pseudopapilledema in children.

Diagnostic performance of optical coherence tomography-derived structural parameters in differentiating pediatric papilledema from pseudopapilledema.

Elie Zaher … Nitsan Duvdevan-Strier

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026

Purpose

To evaluate whether optical coherence tomography (optical coherence tomography)-derived peripapillary retinal nerve fiber layer (retinal nerve fiber layer) thickness measurements can aid in differentiating papilledema from pseudopapilledema in pediatric patients, to assess the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both conditions, and to examine the diagnostic utility of Bruch's membrane opening (BMO) parameters.

Methods

Retrospective cohort study.

Results

kids with true optic-nerve swelling had a thicker optical coherence tomography nerve-fiber layer, reliably telling them apart

Superior quadrant RNFL

0.92AUC

Worse-eye global RNFL

0.89AUC

More results

Eighty-four patients met inclusion criteria, including 49 with papilledema and 35 with pseudopapilledema.

Retinal nerve fiber layer thickness was significantly greater in papilledema across all analyzed parameters.

PHOMS were observed in both groups, with no significant difference in prevalence (p = 0.21).

More results

No significant differences were found in BMO measurements between the groups.

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Conclusion · 1 of 2

Peripapillary retinal nerve fiber layer thickness measurements derived from optical coherence tomography demonstrate meaningful diagnostic value in differentiating papilledema from pseudopapilledema in pediatric patients and may serve as a useful adjunct to clinical evaluation, particularly in diagnostically uncertain cases.

Conclusion · 2 of 2

In contrast, PHOMS and BMO measurements did not reliably distinguish between these entities. Prospective studies are needed to validate these findings and refine clinically applicable diagnostic thresholds.

Post

Diagnostic performance of optical coherence tomography-derived structural parameters in differentiating pediatric papilledema from pseudopapilledema.

Retinal nerve fiber layer thickness on optical coherence tomography accurately distinguishes papilledema from pseudopapilledema in children.

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