Cataracts of the eye may be difficult to diagnose in the early stages.

In a study to evaluate
the reliability of their diagnoses, two physicians each examined the same 1,000 eyes,
without knowing the other’s diagnoses. Each physician found 100 eyes with cataracts.
1. Does this mean that the diagnoses are reliable?
2. Explain your position.
3. How does reliability affect screening and treatment programs
for a condition?
4. What are the socio-political ramifications of understanding
reliability prior to implementing a screening program?

This overall study is lacking a lot of essential information that is needed to determine the study’s
true reliability. The study says that the two physicians examined the same 1,000 eyes without
knowing each other’s diagnosis and that each physician found 100 eyes with cataracts. However,
it was not stated if the eyes that were found to have cataracts, were the same 100 eyes.
Reliability, also known as precision, it is the ability of a measuring instrument to give consistent
results on repeated trials (Epidemiology for Public Health Practice). According to Morrison,
reliability of a test refers to, “ its capacity to give the same result”- positive or negative. To have
more reliable results the doctor should conduct sever tests that include a vassal acuity test which
uses an eye chart to measure how well you can read a series of letter, a slit lamp examination that
allowed your eye doctor to see the structures at the front of your eye under magnification and
lastly a retinal exam (Mayo Clinic). The purpose of a screening test is to classify individuals as
to whether they are likely to have a disease or be disease-free. Along with not conducting he
proper tests, the study also did not include any medical or family history. The two physicians
also did not seem to take into consider any medication, age, or other health problems that the
participants could possibly have. Most cataracts develop when aging or injury changes the tissue
that makes up your eye’s lens (Mayo Clinic). Some inherited genetic disorders that cause other
health problems can increase your risk of cataracts. Cataracts can also be caused by other eye
conditions, past eye surgery or medical conditions such as diabetes. Long term-use of steroids
medications can cause cataracts to develop (Mayo Clinic). The physicians also did not clarify
whether the cataracts are affecting the center lens (nuclear cataracts), the edge of the lens
(cortical cataracts), the back of the lens (posterior subscapular cataracts) or if they were born
with (congenital cataracts)(Mayo Clinic). Other risk factors that should have been taken into
consideration that can increase the risk factor of cataracts include diabetes, smoking, excessive
sunlight or high blood pressure. If the disease of interest were fatal, then the appropriate end
point would be differences in mortality between the two groups. For nonfatal disease, differences
in incidence between the screened and non-screened populations should be estimated
(Epidemiology for Public Health Practice). With that being said, the treatment programs would
be reliable unless all of this information has been taken into consideration and are properly
conducted.

Understanding the ramifications that can occur when a screening program is not properly
implemented is very important because it can cause more harm to the patients, waste money,
waste resources and time. It can cause more harm to the overall study and participants.
Reference:
1. Friis RH, Sellers TA. Epidemiology for Public
Health Practice. Sudbury, MA: Jones and Bartlett;
2014.
2. Mayo Clinic. Cataracts.
http://www.mayoclinic.org/diseases-
conditions/cataracts/symptoms-
causes/dxc-20215129. 2016.