{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:06Z","timestamp":1787755626000,"version":"build-2784847793"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johannes Kepler University Linz"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess whether sociodemographic factors are associated with disease severity in patients with keratoconus treated at a\u00a0tertiary care center within a\u00a0publicly funded healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Kepler University Clinic and Johannes Kepler University, Linz, Austria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This monocentric cross-sectional study assessed socioeconomic factors, quality of life, and objective measurement parameters in patients with keratoconus. Clinical data included best-corrected distance visual acuity (BCDVA) and corneal parameters using anterior segment optical coherence tomography (AS-OCT), including anterior and posterior maximum corneal curvature (K\n                      <jats:sub>max<\/jats:sub>\n                      ), minimum pachymetry (Th\n                      <jats:sub>min<\/jats:sub>\n                      ), and epithelial thickness index (ETI).\n                    <\/jats:p>\n                    <jats:p>Sociodemographic factors and access-to-care variables were assessed using a\u00a0structured questionnaire.  Disease severity and patient-reported outcomes were analyzed according to the Austrian urban-rural typology in order to explore regional and sociodemographic differences. Quality of life and subjective symptoms were assessed using the Rasch-validated Keratoconus Outcomes Research Questionnaire (KORQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A\u00a0total of 105 patients (70.48% male; 29.52% female) were included in this study. The highest anterior K\n                      <jats:sub>max<\/jats:sub>\n                      values were observed in patients from medium-sized urban centers (right eye 55.79\u202f\u00b1\u200913.43\u202fD; left eye 59.78\u202f\u00b1\u200913.30\u202fD). Visual acuity was lowest for major and medium sized urban centers (right eye 0.41\u202f\u00b1\u20090.45 logMAR; left eye 0.47\u202f\u00b1\u20090.38 logMAR).  KORQ\u00a0Scores were highest  in  medium sized (51.71\u202f\u00b1\u20097.21 points) and major urban centers (47.38\u202f\u00b1\u200914.08 points), indicating greater patient-reported disease burden.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sociodemographic factors may contribute to differences in disease severity among keratoconus patients, even within a\u00a0publicly funded healthcare system. Universal health coverage alone may not  ensure equitable access to timely diagnosis and specialized care. Larger studies with multivariable adjustment are needed for underlying these observations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00508-026-02803-y","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:29Z","timestamp":1787751929000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sociodemographic determinants of disease severity in a\u00a0public healthcare system"],"prefix":"10.1007","author":[{"given":"Leon","family":"Pomberger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia Anna","family":"Reifeltshammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Stojanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Honeder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Bolz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nino","family":"Hirnschall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2803_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2025-006317","volume":"12","author":"A Gomez","year":"2026","unstructured":"Gomez\u00a0A, de Guimar\u00e3es Oliveira\u00a0D, Karakikla-Mitsakou\u00a0Z, Koskina\u00a0E, Sporre\u00a0KB, Faustini\u00a0F, et\u00a0al. 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N.\u00a0Hirnschall is a\u00a0consultant for Carl Zeiss Meditec AG and Hoya Surgical. L.\u00a0Pomberger, S.A.\u00a0Reifeltshammer, S.\u00a0Stojanov and A.\u00a0Honeder declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the local Ethics Committee (EK 1315\/2024) and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients included in the study.","order":2,"name":"Ethics","label":"Ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}}]}}