All About Patching
Taken from the American Academy of Ophthalmology
WHEN SHOULD PATCHING BE USED FOR AMBLYOPIA TREATMENT?
Patching is a very effective way of treating many kinds of amblyopia as it forces the brain to pay attention to the image coming from the weaker eye. Patching a young child’s better eye is a challenge and requires a lot of effort, persistence and encouragement from caregivers. The younger the child is, the faster patching works in improving the vision, so caregivers should be persistent in patching as soon as it is prescribed. An ophthalmologist/optometrist should regularly check how the patching is affecting the child’s vision.
Patching the dominant eye allows the weaker eye to get stronger.
ARE THERE DIFFERENT TYPES OF PATCHES?
The classic patch is an adhesive "Band-Aid" which is applied directly to the skin around the eye. They are available in different sizes for younger and older children. For children wearing glasses, both cloth and semi-transparent stickers (Bangerter foils) may be placed over or onto the spectacles. Sometimes parent’s can place opaque/cloudy tape on the glasses over the “good” eye so that the child get’s a clearer image through their weaker eye. "Pirate" patches on elastic bands are especially prone to peeking and are therefore only occasionally appropriate.
IS THERE AN ALTERNATIVE TO PATCHING TO TREAT AMBLYOPIA?
Sometimes the stronger (good) eye can be “penalized” or blurred to help the weaker eye get stronger. Atropine drops will temporally blur the vision in the good eye and are a great alternative to patching in select cases. The eye drop in the better eye forces the brain to pay attention to the image coming from the weaker eye. For mild to moderate degrees of amblyopia, studies have shown that patching or eye drops may be similarly effective. Your pediatric ophthalmologist/optometrist will help you select what treatment regimen is best for your child.
DO DROPS WORK FOR ALL AMBLYOPIC CHILDREN?
Not all children benefit from eye drop treatment for amblyopia. Penalizing eye drops (such as atropine) do not work as well when the stronger eye is nearsighted or when the degree of amblyopia is severe.
HOW MANY HOURS PER DAY PATCHING IS ENOUGH WHEN TREATING AMBLYOPIA?
The prescribed number of hours of patching will depend on the visual acuity in the amblyopic eye and whether treatment has been successful in the past. Your doctor will prescribe the appropriate time for you.
HOW LONG DOES AMBLYOPIA PATCHING THERAPY TAKE TO WORK?
Although vision improvement frequently occurs within weeks of beginning patching treatment, optimal results often take many months. Once vision has been improved, less (maintenance) patching or periodic use of atropine eyedrops may be required to keep the vision from slipping or deteriorating. This maintenance treatment may be needed for several months to years.
DURING WHICH ACTIVITIES SHOULD PATCHING BE PERFORMED?
There is no particular activity that will improve the vision more than another activity. The most important part of treatment is keeping the patch on for the prescribed treatment time. As long as the child is conscious and has his or her eyes open, visual input will be processed by the amblyopic eye. On the other hand, the child may be more cooperative or more open to bargaining if patching is performed during certain, favorite activities (such as watching a preferred television program or video). Some eye doctors believe that the performance of near activities (reading, coloring, hand-held computer games) during treatment may be more stimulating to the brain and produce better or more rapid recovery of vision.
WHAT IF MY CHILD REFUSES TO WEAR THE PATCH?
Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, teachers, etc. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period. Children may also be allowed to do something fun such as watch TV or play video games with the patch on.
WHAT HAPPENS IF AMBLYOPIA IS NOT TREATED?
If amblyopia is not treated in childhood, the vision in the affected eye(s) will be permanently decreased. Our current treatments for amblyopia are not effective in adults.
For most children, the ophthalmologist/optometrist will give the instructions and monitor the progress, but the patient and the family will do the hard work of actually performing amblyopia treatment by patching, glasses or eye drops.
Dr. Topete’s Patching Tips
Establish a routine. Try patching at the same time every day. This makes it less likely to forget to patch when it is done consistently and becomes a habit.
Associate patching with something positive. For example, if your child uses an ipad or plays video games, remind them they need to keep their eye patch on during those fun activities.
Keep a calendar and place a sticker for each day they are able to keep their patch on for their recommended duration.
Some days will be better than others. If there’s a day the child is keeping the patch on well, feel free to keep it on longer to make up for the days when patching is more difficult.
Make sure your child isn’t peeking with their “good” eye. This is a particular problem with pirate patches or patches that go over glasses. You can even place a piece of tissue under those types of patches to decrease peeking.
If the amblyopia is severe, the child will likely be very agitated since their vision is very blurry. Try taking your child outside, use big, bright toys to engage and distract them.
