Dual sensory impairment may limit functional improvement after vision rehab

Investigators from the Wilmer Eye Institute and the Bloomberg School of Public Health at Johns Hopkins University, both in Baltimore, reported in JAMA Ophthalmology¹ that patients with dual sensory impairment (ie, hearing and vision) had a “reduced likelihood of functional improvement following vision rehabilitation.”

The investigators, led by first author Anas Obaideen, MBBS, MPH, suggest that interdisciplinary efforts in rehabilitation may better benefit patients with dual sensory impairment.

They explained that dual sensory impairment is “a complex barrier to daily functioning” that affects many individuals globally, currently 5.5%, and that it is expected to increase by 27.4% in a little over the next two decades. They cited studies that reported that more than 40% of visually impaired individuals are also hearing impaired.^2,3 They also pointed out that dual sensory impairment “is associated with increased odds of cognitive impairment, exceeding the risk associated with single sensory loss.⁴”

At the same time, they reported that little research has focused on whether hearing impairment impacts rehabilitation outcomes.

In light of this, they conducted a cross-sectional study to identify if there is an association between impaired hearing and achieving a clinically meaningful functional improvement after vision rehabilitation.

The data from 611 patients in the Low Vision Rehabilitation Outcomes Study,² a prospective cohort study on clinical outcomes of vision rehabilitation, were analyzed. All were visually impaired and had self-reported hearing status available. Of these patients, 407 had complete follow-up data after rehabilitation.

The main outcome was improved general capabilities compared with before rehabilitation as measured using the Activity Inventory, a validated visual function questionnaire of 459 items subsumed under 50 goals, administered through a computer-assisted interview.⁵ Obaideen and colleagues considered rehabilitation to be effective when a minimum clinically important difference (MCID) was reached, they explained.

What did the data analysis find?

Analysis of the 611 patients (mean age, 73 years) showed that 358 had normal hearing and 253 had self-reported hearing impairment.

The researchers found that “a smaller proportion of participants with hearing impairment achieved a mean MCID after vision rehabilitation (39/169 [23%] vs 74/238 [31%]; odds ratio [OR], 0.58; 95% confidence interval [CI], 0.34-0.95; P = 0.03); this association was not attenuated by possession of hearing aids (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 = 0.04) and higher depressive symptoms (OR, 1.38 per logit increase; 95% CI, 1.17-1.63; P < 0.001) were more likely to achieve an MCID.”

They also explained that in their study, patients with low vision and hearing impairment were older with lower physical health status scores compared to those with normal hearing, both at baseline and after rehabilitation.

“Despite similar baseline visual abilities and self-reported vision impairment severity, participants with hearing impairment were less likely to achieve an MCID in Activity Inventory ability following rehabilitation. This difference persisted regardless of history of hearing aid use and was consistent across all levels of self-reported vision status. These results emphasize the importance of addressing hearing-related barriers within vision rehabilitation care and tailoring treatment for individuals with dual sensory impairment,” Obaideen and colleagues concluded.

References

1. Obaideen A, Goldstein JE, Bradley C, et al. Hearing impairment and visual rehabilitation outcomes. JAMA Ophthalmol. 2026;144:351-7. doi:10.1001/jamaophthalmol.2026.0207

2. Goldstein JE, Jackson ML, Fox SM, Deremeik JT, Massof RW; Low Vision Research Network Study Group. Clinically meaningful rehabilitation outcomes of low vision patients served by outpatient clinical centers. JAMA Ophthalmol. 2015;133:762-9. doi:10.1001/jamaophthalmol.2015.0693

3. Yeo BSY, Gao EY, Tan BKJ, et al. Dual sensory impairment: Global prevalence, future projections, and its association with cognitive decline. Alzheimers Dement. 2025;21:e14465. doi:10.1002/alz.14465

4. Fuller-Thomson E, Nowaczynski A, Macneil A. The association between hearing impairment, vision impairment, dual sensory impairment, and serious cognitive impairment: findings from a population-based study of 5.4 million older adults. J Alzheimers Dis Rep. 2022;6:211-22. doi:10.3233/ADR-220005

5. Massof RW, Ahmadian L, Grover LL, et al. The Activity Inventory: an adaptive visual function questionnaire. Optom Vis Sci. 2007;84:763-74. doi:10.1097/OPX.0b013e3181339efd