Deafness and vision impairment

A child is considered to have an MSI or be deafblind if they have both a degree of hearing loss and visual impairment. 

For some children, deafness can happen as part of a syndrome (a collection of signs or symptoms that appear together). Sometimes a syndrome has already been identified, but if it hasn’t then an eye examination can help to identify a syndrome or confirm that hearing loss is not part of a syndrome.

Deafblind children may have an additional learning disability which can be associated with some syndromes, such as Alström syndrome. It's also possible that significant gaps in experiences and incidental learning will affect a deafblind child's cognitive impairment.

In many cases, there’s no clear reason why a deaf child also has vision impairment.

It is unusual for a child to be equally affected by both degrees of their deafness and their vision impairment. Most children will have a more significant loss in one sense than the other. This balance can also be progressive and may change as they get older. 

As a child's hearing and vision change, their communication preferences and style might change too. 

Find out about communication options for children with MSI.

Children with MSI can find it difficult to process information from multiple senses at the same time. It can be helpful to process information from one sense at a time.

Your child may not identify as deafblind, and that’s OK! However, it’s important for the professionals who work with your child to be aware of both the hearing loss and vision impairment, as well as the impact of both together. For example, if your child wears hearing aids all the time but only wears glasses at school, it’s important to bring their glasses with you to audiology appointments, to make sure the hearing aids and glasses both fit comfortably.

A child with MSI could have input from 3 specialist teachers.

• Teacher of the Deaf (ToD)
• Teacher of Vision Impairment (TVI)
• Teacher of Multi-Sensory Impairment (TMSI)

If your child is identified as having a severe or progressive visual condition, they should be referred to a TVI. TVIs usually work as part of a specialist educational service. The referral could be made by your child’s audiologist, eye clinic, or school.

Around half of local authorities in England employ a TMSI. TMSIs are trained to support children with vision and hearing loss to develop and learn.

Not all children with MSI will get support from a ToD, TVI or TMSI. It depends on the degrees of vision and hearing loss, as well as what's available in your area.

The charity Sense can provide support and advice to families of deafblind children. They can also help you advocate for your child’s rights.

Children with permanent sensorineural deafness are at higher risk of eye disorders than hearing children. In addition to the normal childhood vision screening, the Royal College of Ophthalmologists (eye doctors) guidance recommends that children with sensorineural deafness have further eye checks.

If your child has sensorineural deafness, your audiologist or another health professional might refer them for an eye test. You might have to request this referral yourself. Ideally, children with sensorineural deafness should see both an orthoptist and an ophthalmologist.

An orthoptist is a specialist who can diagnose, manage and treat vision impairments.

An ophthalmologist is a doctor who specialises in eye and vision care. They can diagnose, treat and prevent diseases and disorders of the eye, and can also perform eye surgery.

Here are some tips for eye appointments.

• Remind staff about deaf awareness, such as keeping the light on their face and facing your child when speaking.
• Make sure your child understands what’s going to happen before each test and before the lights are turned off.
• Remind staff that your child may not understand them when the lights are turned off.
• Take along any medical records to share with your clinician.
• Bring any hearing devices (such as hearing aids or implants) to the eye appointment, even if your child doesn’t want to wear them on the day.
• If your child uses British Sign Language (BSL), remind the eye clinic to book an interpreter for their appointment.
• If your child has problems with their balance, they may need time to get their balance back after the eye tests and examinations are finished.

Very young babies are still developing their vision. It is difficult for babies to communicate what they can see. However, there are a range of checks and tests which can still provide useful information about a baby's vision.

Wearing hearing aids and glasses together may seem a bit daunting, especially for a small child. It’s very important that your child feels comfortable with them.

Your optometrist and audiologist need to work together to help get the best fit. Often the arm of the glasses can be adjusted by your optometrist to give a better fit next to the hearing aid.

Metal-framed glasses for children usually take up less space and wrap around the ear. These may be more suitable for your child than plastic framed glasses. Glasses with soft supports for the ear pieces may help.

If your child has lazy eye (amblyopia), they may have to wear a patch on the good eye to help the lazy eye come into line with the other one. If your child needs to lip-read and follow sign language, make this clear to the orthoptist. Speak to them about any adjustments that could be made.

It may be helpful to get advice from a specialist teacher (such as a ToD, TVI or TMSI ) to help with managing equipment and developing activities that will encourage a child to accept patching and glasses.