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Background and purpose: In idiopathic intracranial hypertension (IIH), magnetic resonance imaging (MRI) features are promising diagnostic markers, but the impact of rater experience and the specific referral question is unknown. Methods: From the Vienna Idiopathic Intracranial Hypertension database, patients were included with definitive IIH and routine cranial MRI performed during diagnostic work‐up. Frequencies of partial empty sella (ES), optic nerve sheath distension (ONSD), optic nerve tortuosity (ONT), posterior globe flattening (PGF) and transverse sinus stenosis (TSS) were compared in three settings: (i) real‐world rating, (ii) junior neuroradiologist without special IIH training and (iii) senior neuroradiologist with experience in IIH imaging (gold standard). Results: Magnetic resonance imaging scans of 84 IIH patients (88% female, mean age 33.5 years) were evaluated. By gold standard, ONSD was the most frequent (64.3%) followed by TSS (60.0%), ONT (46.4%), ES (44.4%) and PGF (23.8%). Compared to the gold standard, IIH features were described significantly less frequently in routine MRI reports (ONSD 28.6%, ONT 13.1%, PGF 4.8%, TSS 42.9%, p < 0.01 respectively) except for ES (42.9%, p = 0.9). A specific referral question regarding IIH increased detection rates in routine reports, but rates remained significantly lower than by gold standard. In contrast, a rating by a neuroradiologist without special training produced significantly higher frequencies of ONSD (81.0%, p < 0.01) and ONT (60.7%, p < 0.01) but not of ES (47.6%), PGF (29.8%) and TSS (68.1%). Conclusions: Idiopathic intracranial hypertension MRI features are underestimated in routine MRI reports and partly overcalled by less experienced neuroradiologists, driven by features less well known or methodologically difficult. Reevaluation of MRI scans by an experienced rater (and to a lesser degree a specific referral question) improves diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background/Aims Optical coherence tomography (OCT) is commonly used to diagnose and assess diabetic macular oedema (DME). Swept-source OCT (SS-OCT) promises improved imaging depth and more independence from media opacities. Heidelberg Spectralis full-depth imaging (FDI) combines details at different depths to one representation. The aim of this study was to determine the comparability of the imaging methods concerning DME ultrastructure.///Methods Two graders assessed the presence of typical DME phenomena in eyes with centre-involving DME on Topcon Atlantis SS-OCT and Heidelberg Spectralis FDI spectral-domain OCT (SD-OCT) B-scans. Retinal layer segmentation was corrected and choroidal layers were manually segmented. Graders measured cyst and subretinal fluid (SRF) diameters and counted hyper-reflective foci (HRF). Findings were recorded and statistically analysed.///Results Statistically significant systematic biases (Spectralis-Atlantis) were found for the HRF count (outside the central mm, -6.39, p=0.0338), chorioretinal thickness (central mm: -35.45 μm, p=0.00034), choroidal thickness (central mm: -60.97 μm, p=0.00004) and Sattler's layer thickness (-42.69 μm, p=0.0001). Intergrader agreement was excellent or very good for posterior vitreous detachment, vitreomacular attachment (central mm) and SRF presence in both devices. Manually delineated Sattler's layer thickness showed an intraclass correlation of 0.85 with FDI SD-OCT but 0.26 with SS-OCT (p=0.003).///Conclusion Prominent aspects such as cysts in the outer nuclear layer and SRF can be identified with comparable confidence, while a significant systematic bias underlies chorioretinal, choroidal and Sattler's layer thickness and HRF count. Specialists should use the same device at every examination during longitudinal clinical consideration or cross-sectional evaluation of these ultrastructural biomarkers. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the short‐time effect of intravitreal injections (IVI) of the vascular endothelial growth factor inhibitors ranibizumab and aflibercept on retinal arterial and venous oxygen saturation (SO2a and SO2v), arteriovenous oxygen saturation difference (AVD) and vessel diameter (VDa and VDv) in patients with diabetic macular oedema (DME) and patients with choroidal neovascularization (CNV) due to age‐related macular degeneration. Methods: Uncontrolled prospective observational study in 100 eyes. Retinal vessel oxygen saturation and diameters were assessed using a retinal oximeter before and minutes after IVI of ranibizumab or aflibercept. Results: 40 eyes with CNV and 34 eyes with DME were included in the analysis. At baseline, SO2a and SO2v were significantly higher in DME (p = 0.043 and p = 0.009, respectively). After IVI, SO2a significantly decreased in CNV and DME eyes by 2.6% (p = 0.016) and 4.6% (p = 0.002) and SO2v decreased by 14.0% (p = 0.004) and 12.4% (p = 0.017), respectively. However, a significant increase in AVD was only found in CNV (15.7%, p = 0.001). VDa decreased significantly only in DME by 5.7% (p = 0.010). No medication‐specific disease effect was found and vice versa. Conclusions: The observed changes can be interpreted as signs of increased metabolic demand during the physiological stress after an IVI. The abnormal arterial constriction and the abolished increase in AVD seen only in eyes with DME indicate an impairment of vascular autoregulation and oxygen distribution and a reduced neuroretinal metabolism in the diabetic retina with a significant impact on inner retinal oxygen consumption shortly after IVI. [ABSTRACT FROM AUTHOR]

Background: Patient adherence is an important component of an efficient therapy. For diabetes patients it may contribute to controlled glucose values and reduction of adverse outcomes. Objectives: We aim to examine a potential association of Lower Austrian diabetes patients' adherence concerning their disease monitoring and mortality. Methods: Using a retrospective cohort study design, claims data of 55,873 diabetes patients were examined for regular HbA1c lab tests that served as a proxy for monitoring related adherence. The cumulative incidence of mortality was estimated in the total study population and separately for different levels of adherence using the product-limit method. Mortality was compared between the different levels of adherence by the log-rank test. Results: The cumulative incidence of mortality after one and two years was 4.2% and 8.7%. Patients with low adherence had a significantly higher risk of mortality than patients with high adherence (p<0.001). Further results of a multivariable analysis will be presented at the conference. Conclusion: According to our preliminary univariate analysis, monitoring related adherence seems to be substantially beneficial for diabetes patients in Lower Austria. [ABSTRACT FROM AUTHOR]

The management of diabetic retinopathy, a frequent ophthalmological manifestation of diabetes mellitus, consists of regular examinations and a standardized, manual classification of disease severity, which is used to recommend re-examination intervals. To evaluate the feasibility and safety of implementing automated, guideline-based diabetic retinopathy (DR) grading into clinical routine by applying established clinical decision support (CDS) technology. We compared manual with automated classification that was generated using medical documentation and an Arden server with a specific medical logic module. Of 7169 included eyes, 47% (n=3373) showed inter-method classification agreement, specifically 29.4% in mild DR, 38.3% in moderate DR, 27.6% in severe DR, and 65.7% in proliferative DR. We demonstrate that the implementation of a CDS system for automated disease severity classification in diabetic retinopathy is feasible but also that, due to the highly individual nature of medical documentation, certain important criteria for the used electronic health record system need to be met in order to achieve reliable results. [ABSTRACT FROM AUTHOR]

Due to the increasing use of Electronic Health Records by healthcare providers and the trend towards the use of Personal Health Records by patients the potential need to integrate these two types of medical documentation emerged. The introduction of the ELGA (Elektronische Gesundheitsakte, EHR) during the next few years is reason enough to propose possibilities to directly involve the patient into the data acquisition process in form of generating personal health data (e.g. vital signs, etc.) at home. In particular patients with chronic diseases will benefit from this integrated architecture. Furthermore, patients could archive all documents for their own use and responsibility. This article reviews literature about integration possibilities for personal and electronic health records and proposes an architecture which integrates data from patient-side into an affinity domains’ XDS document repository. [ABSTRACT FROM AUTHOR]

Significant improvements in the field of diagnostic methods and therapeutic options achieved during the last decade allow the early diagnosis, accurate follow-up and individual indication for the treatment with highly efficacious therapeutic agents in a wide range of ophthalmological pathologies. The burden on health care systems is extremely high, as treatment and diagnostic follow up has to be repeated in a regular manner. Whereas the treatment can only be applied in tertiary care centers (eye clinics), follow-up and management mainly depends on the OCT technology, which is becoming available at many field ophthalmologists’ practices. This article describes the OphthalNet project, a network which optimizes collaboration between eye clinics and field ophthalmologists based on medical guidelines, workflow support and the future use of electronic infrastructure. [ABSTRACT FROM AUTHOR]

Background: Two years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented. Objectives: To assess the completeness of information documented electronically compared with manually during patient visits. Methods: The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared. Results: In all categories, clinical documentation was more complete in the EHR group. Conclusions: In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness. [ABSTRACT FROM AUTHOR]