A. Maintain observation
Diabetic papillopathy is an uncommon condition found among patients with type 1 or 2 diabetes that can be mistaken for neovascularization of the disc (NVD). Diabetic papillopathy can classically be differentiated from NVD by its radially oriented telangiectasias, which do not extend into the vitreous, while NVD has a random branching pattern and can extend into the vitreous.1,2 Diabetic papillopathy has a favorable prognosis, and most cases resolve spontaneously within 4 to 8 months.1,2 Small observational studies have reported improvement of optic disc edema with intravitreal or periocular steroids,3 vascular endothelial growth factor inhibitors (choice C),4 or panretinal photocoagulation (choice D).5 However, there appear to be no strong data for such treatments, and diabetic papillopathy can typically be observed. Magnetic resonance imaging of the brain (choice B) can be considered if compressive optic neuropathy or papilledema is suspected; unilateral papilledema cases have been reported but are uncommon.6 While it is not unreasonable to rule out these conditions with imaging, the absence of an afferent pupillary defect or other neurological deficits make these diagnoses less likely.