An Overview of Preschool Vision Screening

Although several vision screening techniques are available for infants, including Optokinetic Nystagmus, Preferential Looking and Visual Evoked Potential, none is routinely utilized. Visual deficits are often first detected through required preschool vision screenings. These screenings vary in their comprehensiveness and administration. No standardization for testing or administration exists. Referrals for further examination appear to be higher for those children receiving a thorough battery, suggesting that some of the testing procedures used have inappropriately high rates of false negatives.

Vision Screening: A Study of 297 Head Start Children

Vision assessments were provided to 297 Head Start children in nine Westchester County, New York programs. An optometrist and an orthoptist administered a protocol which included retinoscopy, visual acuity, fly, cover, motility and convergence tests. Sixty-three children (21.2%) were referred for further evaluation. The visual deficits detected by this screening included decreased acuity, strabismus combined with decreased acuity, astigmatism, and nonspecific visual problems. The protocol used provided a thorough evaluation of the visual system and required only seven minutes per patient.

Acute care hospital utilization by patients with visual impairment

OBJECTIVE

To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities.

METHODS

We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379).

RESULTS

The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60,085), and 8.2 days for patients with no visual impairment (N = 2,546,586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001).

CONCLUSIONS

Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.

A therapeutic work program for head-injured adults

The Therapeutic Work Program operates in an ambulatory care setting and aids in assessing and developing prevocational skills in adults with head injuries. The program has eight phases, including initial evaluation, individual and group treatment, and prevocational assessment and treatment. We conducted a phone survey to evaluate the program's effectiveness and found that 79% of the 29 respondents participated in occupational activities (i.e., they were competitive or volunteer employees, homemakers, or students), a greater percentage than reported by other prevocational programs for patients with head injuries.

DNA hybridisation of cervical scrapes: comparison with cytological findings in Papanicolaou smears

One hundred and sixty four cervical scrapes were taken over 26 months from 143 women aged 17 to 53 years, using an Ayre spatula. A smear was prepared from each sample for Papanicolaou staining and for cytological examination for evidence of human papillomavirus (HPV) infection. The cells remaining on the spatula were harvested for DNA analysis. These samples were probed for HPV 6, 16, and 18 and the results of DNA hybridisation and cytology were compared. Cytological changes of HPV (anucleate keratinised and keratinised squamous cells, koilocytic change and dyskeratosis, or multinucleation, or both) were detected in 103 (72%) of the samples where HPV DNA was detected; koilocytic changes were present in only 67 (48%). It is concluded that screening for a range of viral changes is a more sensitive method of detecting HPV infection than screening for koilocytic change alone.

Distribution of epithelial membrane antigen in normal and abnormal endometrial tissue

The distribution of epithelial membrane antigen (EMA) on normal and abnormal endometrial tissue was studied as a method for distinguishing atypical hyperplasia from adenocarcinoma. Histological sections from 47 patients (nine adenocarcinoma, nine atypical hyperplasia, nine cystic hyperplasia, 19 normal endometrium and one sarcoma) were studied with an immunocytochemical alkaline phosphatase technique that demonstrated EMA. At a dilution of 1:1000 the majority of normal tissue was negative whereas all the abnormal tissue stained positively. At a slightly higher dilution all adenocarcinomas expressed the antigen although only a few of the hyperplastic lesions (16%) stained with the antibody. The value of this approach for automated screening is discussed.

Prognostic significance of herpes simplex virus antibody status in women with cervical intraepithelial neoplasia (CIN)

A total of 107 women with abnormal cervical smears showing cytological changes consistent with cervical intraepithelial neoplasia (CIN) 1 or CIN 2 were kept under regular cytological, colposcopic, virological and serological surveillance for an average of 18 months (range 9 months-3 years). Regression of the cervical lesion was noted in 31 (29%) and progression to CIN 3 in nine women (8.4%). We found a positive correlation between the presence of type 2 antibody and progression of CIN 1 and 2 to CIN 3 and a negative association with the presence of type 1 antibody and suggest the antibody status of a woman with CIN 1 or CIN 2 may provide a useful basis for follow-up. We found no association between the outcome of the cervical lesion and active infection with herpes simplex or cytomegalovirus or any other infectious agent or sex-related factors.

Reliability of endometrial aspiration cytology in the assessment of endometrial status

One hundred twenty women attending routine gynecologic clinics were investigated by endometrial aspiration cytology to determine whether outpatient assessment of endometrial status could be used to determine subsequent patient management. The results show that this technique allows recognition and distinction between cystic hyperplasia, adenomatous hyperplasia, and carcinoma, and the time of the menstrual cycle can be assessed when the endometrium is normal. Endometrial aspiration cytology is valuable in gynecologic practice for determining which women with abnormal bleeding, both premenopausal and postmenopausal, require further investigation. Furthermore, the technique has a role to play in monitoring the status of the endometrium in women at high risk of endometrial malignancy, particularly those receiving hormone replacement therapy.

Aspiration cytology versus histology in the assessment of the endometrium of women attending a menopause clinic

The endometrium of 100 women attending a menopause clinic was assessed cytologically, using the Isaacs cell sampler, and then histologically, using the Vabra suction curette. Satisfactory specimens for diagnosis were obtained in 96 per cent of cases with the Isaacs cell sampler and in 62 per cent of cases with the Vabra suction curette. There were eight discrepancies between the diagnoses obtained by the cytological and histological methods and these are analysed. Thirty patients were asked to grade the discomfort experienced during the procedures, and of these 26 found the Vabra method more painful than the Isaacs method.

Relation between the karyopyknotic index and plasma oestrogen concentrations after the menopause

The karyopyknotic index correlated significantly (p less than 0.001) with the plasma oestradiol but not plasma oestrone concentration in 38 postmenopausal women. This ties with previous findings that postmenopausal women with superficial dyspareunia have a more severe degree of vaginal atrophy than asymptomatic women, and that oestradiol is probably more important biologically than oestrone.

Endometrial assessment with Isaacs cell sampler

The value of the Isaacs endometrial cell sampler in the cytologic assessment of the endometrium was studied in 121 unanaesthetised patients aged over 40. Satisfactory aspirates for cytological diagnosis of endometrial state were obtained in 111 patients (91%) whereas endometrial specimens for histological diagnosis were obtained in only 89 patients (79%). In only four out of 83 cases were there diagnostic discrepancies between the aspirates and the curettings. It is concluded that the technique is safe, quick, comfortable, and reliable for assessing endometrial state. It should therefore prove valuable for screening, particularly in the management of menopausal women requiring oestrogen treatment.