Association Between Microvascular Retinal Signs and Age-Related Hearing Loss in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Abstract

IMPORTANCE Given that age-related hearing loss is highly prevalent and treatable, understanding its causes may have implications for disease prevention.OBJECTIVE To investigate whether microvascular retinal signs are associated with age-related hearing loss attributable to a hypothesized underlying shared pathologic entity involving microvascular disease. DESIGN, SETTING, AND PARTICIPANTSThe Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) is a community-based prospective cohort study of 15 792 men and women aged 45 to 64 years at baseline. The ARIC-NCS participants returned for a fifth clinic visit in 2011-2013 and a sixth clinic visit in 2016-2017. Participants were recruited from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis suburbs, Minnesota). Participants included a subset of the ARIC-NCS cohort with complete covariate data who underwent retinal fundus photography at visit 5 (2011)(2012)(2013) and completed hearing assessment at visit 6 (2016-2017) (N = 1458). Overall, 453 participants had diabetes; of those, 68 had retinopathy. Of 1005 participants without diabetes, 42 had retinopathy.EXPOSURES Microvascular retinal signs included retinopathy, arteriovenous (AV) nicking, and generalized arteriolar narrowing measured using the central retinal arteriolar equivalent (CRAE). MAIN OUTCOMES AND MEASURESHearing was measured using the better-hearing ear pure-tone average (PTA) of air conduction speech thresholds (0.5, 1, 2, and 4 kHz). Multivariable-adjusted linear and ordered logistic regression was used to estimate the association between microvascular retinal signs and age-related hearing loss to describe the precision of the estimates and provide a plausible range for the true association. RESULTS After full adjustment among 1458 individuals in the analytic cohort (mean [SD] age, 76.1 [5.0] years [age range, 67-90 years]; 825 women [56.6%]; 285 black [19.5%]), the difference in PTA per dB hearing level in persons with and without retinopathy was 2.21 (95% CI, −0.22 to 4.63), suggesting that retinopathy is associated with poorer hearing, although the width of the 95% CI prevents definitive conclusions about the strength of the observed association. Restricting the analysis to participants without diabetes, the difference in PTA associated with retinopathy was even greater (4.14; 95% CI, 0.10-8.17 dB hearing level), but the large width of the 95% CI prevents definitive conclusions about the association. In analyses quantifying the mean differences in hearing thresholds at individual frequencies by retinopathy status, the estimates trended toward retinopathy being associated, contrary to expectation, with better high-frequency hearing. At 8 kHz, the estimated difference in hearing thresholds in persons with retinopathy vs those without was −4.24 (95% CI, −7.39 to −1.09). CONCLUSIONS AND RELEVANCEIn this population-based study, an association between the presence of microvascular retinal signs and hearing loss was observed, ...

Association Between Retinal Pathology and Hearing in Older Adults

“… 15 More recently, Kim et al studied patients aged 45 to 64 and found that retinopathy was significantly associated with better rather than worse higher‐frequency hearing. 16 The difference in findings between our study and prior studies may be attributed to differences in the demographics of our cohort. Prior work has shown that the relationship between retinal pathology and hearing loss can be elucidated by examining the degree of microvascular pathology, with only those with more severe maculopathy or diabetic retinopathy being associated with worse hearing loss.…”

“…They found an association between retinopathy and low‐frequency hearing loss in women only 15 . More recently, Kim et al studied patients aged 45 to 64 and found that retinopathy was significantly associated with better rather than worse higher‐frequency hearing 16 . The difference in findings between our study and prior studies may be attributed to differences in the demographics of our cohort.…”

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