Background <p>Idiopathic Intracranial Hypertension (IIH) is a syndrome that requires frequent monitoring and long-term follow-up. The shortage of neuro-ophthalmologists, along with the high burden of frequent visits, raise the need to establish a telemedicine model for follow-up and treatment of IIH patients. The aim of this study is to evaluate the feasibility of a Heidelberg Spectralis Optical Coherence Tomography (OCT)-based Telemedicine model for IIH patients.</p> Methods <p>Treatment recommendations made by the same physician during real clinic visits, in which the patient was physically examined in the clinic, were compared to those based solely on a simulated remote consult, in which the physician reviewed only the patient’s medical history, OCT Retinal Nerve Fibre Layer (RNFL) scan results and Humphrey Visual Field (HVF) without seeing the patient in person. The agreement rate was evaluated.</p> Results <p>Among 62 patient visits included in the study, 54 (87%) were female, with a mean age of 30 (range 6–64). The total agreement rate between two visits type was 87%. The overall kappa measure for the level of agreement between the telemedicine and original decision, was 0.763 (<i>p</i> &lt; 0.001), reflecting high agreement. Changes in the OCT RNFL thickness, along with the presence of an enlarged blind spot, tended to result in greater discrepancies between decisions. Conversely, the absence of current medical treatment inclined toward a better agreement between both types of encounters.</p> Conclusions <p>In this cohort, simulated remote consult treatment recommendations were predominantly similar to real clinic visit recommendations.</p>