Hearing Impairment and Visual Rehabilitation Outcomes.

Abstract

Dual sensory impairment-that is, concurrent hearing and vision impairment-is common in aging populations. Individuals with dual sensory impairment face unique social and functional challenges, but the benefit of conventional rehabilitation in addressing these challenges is not well researched. To determine the association between hearing impairment and the likelihood of achieving a clinically meaningful functional improvement following vision rehabilitation. This was a cross-sectional analysis of data collected by the Low Vision Rehabilitation Outcomes Study, a prospective cohort study on clinical outcomes of vision rehabilitation. Data were included from outpatient low vision rehabilitation services provided at 28 clinical centers across the US between April 2008 and May 2011. The analyses included 611 adults with vision impairment and available self-reported hearing status. Of these, 407 had complete postrehabilitation follow-up data. Data were analyzed from July 2024 to March 2025. Self-reported hearing impairment status at baseline (normal hearing vs hearing impairment). The primary outcome was the improvement in general capability as measured by the Activity Inventory before and after rehabilitation, computed using the method of successive dichotomizations. Rehabilitation was considered effective if the improvement reached a minimum clinically important difference (MCID). Multivariable logistic regression was used to evaluate the association between hearing impairment and achieving MCID. Covariates included age, sex, visual, psychological, physical, and cognitive status. Among the 611 participants (mean [SD; range] age, 73 [15.3; 19-101] years; 403 [66%] female), 358 had normal hearing and 253 had self-reported hearing impairment. Baseline ability did not differ by hearing status (β, -0.08; 95% CI, -0.56 to 0.41; P = .75). However, a smaller proportion of participants with hearing impairment achieved MCID following vision rehabilitation (39/169 [23%] vs 74/238 [31%]; odds ratio [OR], 0.58; 95% CI, 0.34-0.95; P = .03); this association was not attenuated by possession of hearing aid (17/74 [23%] vs 21/95 [22%]). In addition to better hearing status, participants with severe vision impairment (OR, 3.32; 95% CI, 1.2-11.86; P = .04) and higher depressive symptoms (OR, 1.38 per logit increase; 95% CI, 1.17-1.63; P < .001) were more likely to achieve MCID. In this study, self-reported hearing impairment was associated with reduced likelihood of functional improvement following vision rehabilitation. These findings support the need for interdisciplinary efforts in rehabilitation programs to better serve individuals with dual sensory impairment.