Objective:

To evaluate a method for differentiating true papilloedema from pseudo-papilloedema using optical coherence tomography (OCT) measurements of retinal layer thickness above the peripapillary hyperreflective ovoid mass-like structure (PHOMS), highlighting the clinical significance of accurate differentiation.

Key Findings:

• PHOMS can be classified into three types: ODD-associated, anomalous-disc-associated, and optic disc oedema-associated, with implications for diagnosis and treatment.
• Type 3 PHOMS indicates true papilloedema, while types 1 and 2 indicate pseudo-papilloedema, which is crucial for clinical decision-making.
• The study hypothesizes that PHOMS UP thickness is significantly greater in true papilloedema compared to pseudo-papilloedema, suggesting a measurable diagnostic criterion.

Interpretation:

The differentiation between true and pseudo-papilloedema using PHOMS UP thickness measurements could provide a non-invasive diagnostic tool, potentially transforming clinical approaches to these conditions.

Limitations:

• The study may be limited by the retrospective design and potential biases in patient selection, which could affect the generalizability of the findings.
• OCT graders were not masked to clinical diagnosis, which could influence assessment and introduce bias.

Conclusion:

The findings suggest that PHOMS UP thickness measurements may aid in distinguishing between true and pseudo-papilloedema, with significant implications for patient management.