AIM: To compare the optic nerve head (ONH) perfusion in both eyes of unilateral idiopathic macular hole (IMH) with normal control group by using optical coherence tomography angiography (OCTA) and investigate its correlationship with the macular blood perfusion. METHODS: We performed a prospective and cross-sectional study that included 19 patients with full-thickness unilateral IMH and 24 age-and sex-matched controls. All participants received OCTA test. The ONH perfusion was evaluated by the regions of peripapillary and whole en face (the sum of peripapillary and optic disc). The potential correlationship between ONH and parafovea were implied. All the data were performed using the nonparametric test. RESULTS: The mean values of ONH presented that normal control > IMH > unaffected eyes. A statistical variation was found between three groups in the region of temporal (P=0.007). Vessel density notablely decreased on the layers of superficial, deep and choroid of parafovea region in IMH group. The correlative coefficients showed that respectively whole en face and deep retina: r=0.528, peripapillary and deep retina: r=0.525, whole en face and choriocapillaries: r=0.569, peripapillary and choriocapillaries: r=0.504. CONCLUSION: Our study demonstrate a reduced ONH vessel density in both eyes of IMH patients and the vessel density of ONH in IMH eyes are positively correlated with both the retina capillary and choriocapillary in parafoveal. The reduction of vessel densities may indicate the hypoperfusion in IMH eyes.