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Visual and Hearing Impairment
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Patients aged 50 years and over should be asked about their vision and have their visual acuity measured using the Snellen chart (B).
Annual questioning about hearing impairment is recommended for people 65 years of age and over (B)
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Epidemiology
Eye disease and vision impairment increase threefold with each decade of life after 40 years of age. People at greater risk of vision loss are older people and those with diabetes and a family history of vision impairment. Over 80% of vision loss is caused by five conditions: age related macular degeneration, cataract, diabetes, glaucoma, and uncorrected refractive error. Only half of those with diabetes have a regular eye exam and one-third have never been checked. One person in 10 will develop glaucoma but half of those with glaucoma do not know they have it.
Who is at higher risk of visual impairment and hearing loss?
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Who is at higher risk?
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What should be done?
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How often?
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Increased risk for visual impairment
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All people 50-64 years of age
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Screen for vision impairment
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Every 5 years
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Increased risk for visual and hearing impairment
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All people 65 years of age or over
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Screen for vision impairment Screen for hearing impairment
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Every 12 months
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High Risk Group
People with special risks such as the following may need an eye exam more frequently.
- Diabetes
- Previous eye trauma
- Surgery
- Family history of glaucoma
Recognizing a hearing loss is the first step toward treatment.
For a quick assessment
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I May Have a Hearing Loss
Answer YES or NO to the following questions
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- Do you avoid talking on the telephone because you frequently miss parts of the conversation?
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- Do you have trouble hearing someone speaking to you from across the room?
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- Do others comment on how loud you turn up the volume on the TV or the car radio?
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- Do you often sit up front in a meeting so that you can hear well?
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- Do you frequently have trouble hearing people with soft voices?
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- Are there group activities that you used to enjoy but do not take part in anymore?
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- Do friends or family members often comment on your ability to hear?
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- Do you find yourself wondering why everyone seems to mumble when they speak to you now?
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- Do you find yourself frequently asking people to repeat what they have just said to you?
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- Do you have trouble following topic changes in a group of three or more people?
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If you've answered YES to 2 of these questions, a hearing loss may be suspected.
If you've answered YES to 3 or more of the above questions, a complete hearing evaluation by a hearing care professional is recommended.
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Intervention and Scientific Evidence
Screening of visual impairment
Use a Snellen chart to screen for visual impairment in the elderly. There is some evidence that new generation (panoptic) opthalmoscopes can better detect macular degeneration, diabetic retinopathy and glaucomatous discs (B)
Above 65years Hearing Impairment Screening
A whispered voice out of field of vision has a high sensitivity for hearing loss, as does a single question about hearing difficulty
Exposure to excessive noise
A sound's loudness is measured in decibels (dB). In general, sounds above 85 are harmful, depending on how long and how often you are exposed to them and whether you wear hearing protection, such as earplugs or earmuffs.
- Screening older adults for hearing impairment by periodically questioning them about their hearing, counseling them about the availability of hearing aid devices, and making referrals for abnormalities when appropriate, is recommended (“B” recommendation).
- Routine screening of working adolescents and adults is usually limited to those in high-risk occupations (e.g. airport ground crew, musician, factory workers, carpenters) involving exposure to excessive noise levels
- The whispered voice test is one simple clinical technique used to assess hearing. Reported sensitivities and specificities have been 70-100% using pure-tone audiometry as the reference standard, but there are inadequate data on interobserver variability. The free-field voice, tuning fork, and finger rub tests have been criticized on similar grounds. The self-assessment questionnaire to identify hearing impairment probably represent the most rapid and least expensive way to screen for hearing loss in the adult (see above table).
- Among older persons, however, in whom the rate of hearing impairment is high, recommended screening methods for detecting hearing loss have included written patient questionnaires, clinical history-taking and physical examination and audiometry. These screening tests have not been fully evaluated.
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