Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function

Abstract

BackgroundHearing impairment, vision impairment, and dual impairment (both hearing and vision impairment), have been independently associated with functional and cognitive decline. In prior studies of dual impairment, vision impairment is generally not defined or defined by visual acuity alone. Glaucoma is a leading cause of blindness and does not affect visual acuity until late in the disease; instead, visual field loss is used to measure vision impairment from glaucoma.ObjectiveTo examine the effect of glaucomatous visual field loss and hearing impairment on function.DesignCross-sectional.SettingHospital-based clinic in Baltimore, Maryland.Subjects220 adults, ≥55 years presenting to the glaucoma clinic.MethodsVision impairment was defined as mean deviation on visual field testing worse than -5 decibels in the better eye, and hearing impairment was defined as pure tone average worse than 25 decibels on threshold audiometry testing in the better ear. Standardized questionnaires were used to assess functional status.ResultsFive participants were excluded for incomplete testing, leaving 32 with vision impairment only, 63 with hearing impairment only, 42 with dual impairment, and 78 controls with no hearing impairment or vision impairment. Participants with dual impairment were more likely to be older and non-White. Dual impairment was associated with significantly more severe driving limitation and more difficulty with communication compared to those without sensory impairment when adjusted for age, race, gender and number of comorbidities.ConclusionOlder individuals with glaucoma and hearing loss seem to have generally poorer functioning than those with single sensory loss. Health professionals should consider visual field loss as a type of vision impairment when managing patients with dual impairment.

Older adults with dual sensory loss in rehabilitation show high functioning and may fare better than those with single sensory loss

“…Nonetheless, surprisingly, in our sample of older adults that have accessed rehabilitation service, having DSL was related to better results on comprehension of communication, compared to HL alone. This finding differs from that of a prior study which found that DSL is associated with greater communication difficulties compared to HL [ 21 ]. These contrasting results may arise from methodological discrepancies between our studies, specifically this prior study used a different measure of communication function to ours and whereas we assessed sensory impairment based on self-report, they did so using objective measures.…”

“…A 2012 review suggested that the psychosocial and functional effects of DSL often, but not always, are larger than those of single sensory impairment, and that the mixed results likely depend of the type of task measured [19]. More recent research reports mixed results in the areas of physical, cognitive and mental health [20,21]. For instance, it is unclear whether DSL is associated with a greater risk of mortality compared to single sensory impairment.…”

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment

“…Furthermore, 13.8% of those with blindness and 8.6% of those with severe VI had a diagnosed concomitant hearing impairment, as compared to 0% in the other groups (P=0.002); this may have been associated with their older age 34 and worse functioning than VI alone. 35 , 36 …”

Age-Related Diseases and Driving Safety

“…However, two studies are not enough to conclude an enhanced risk for older drivers with hearing impairment, and no further studies on this topic were found. Individuals with hearing loss often show compensatory behavior such as driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities, which likely mitigates driving problems due to poor hearing [48]. Older drivers with a combination of visual and hearing impairment (dual sensory impairment) reported more driving difficulties [49] and a greater restriction of driving skills [43] than patients with isolated visual or hearing disorders or no sensory impairments.…”

“…Individuals with hearing loss often show compensatory behavior such as driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities, which likely mitigates driving problems due to poor hearing [ 48 ]. Older drivers with a combination of visual and hearing impairment (dual sensory impairment) reported more driving difficulties [ 49 ] and a greater restriction of driving skills [ 43 ] than patients with isolated visual or hearing disorders or no sensory impairments. Clearly, more research on the impact of hearing problems and dual sensory impairment on driving behavior and safety is needed.…”