Patching, or ‘Occlusion Therapy’, is prescribed for cases where there is a difference in acuity between the patient’s two eyes, in other words the patient can see better with one eye than the other. The patient naturally prefers the ‘good’ eye and the weaker eye can become lazy and develop amblyopia (also known as a ‘lazy eye’). ‘Patching’ means wearing a patch to cover up the good eye, forcing the brain to use the weaker eye. This can be very effective in strengthening the weaker eye, although the outcome depends on many things, such as the individual case history, the degree of amblyopia (mild or severe), the age of the patient, and of course how successful the patient is at wearing the patch for the prescribed amount of time.
Different kinds of patches
Various kinds of patches are available, and you may need to try a few to see which one suits your child best. The most common are disposable adhesive (sticky) patches, which stick on to the child’s face like a sticking plaster. These are effective in making sure the child cannot ‘cheat’ and use their stronger eye; however it can be painful to tear the patch off and the adhesive can irritate sensitive skins. If the adhesive is weaker, and the patch is less painful to remove, then the child may tear the patch off themselves. These are available in a peachy ‘flesh’ tone or in brighter colours and different designs. Manufacturers include Opticlude and Ortopad. Some parents use baby oil, E45 cream or milk of magnesia when removing the patch to soothe the skin.
The other popular type of patch is a fabric patch which slides on over glasses. These are specially designed to cut out peripheral vision as well as covering up the lens of the spectacles. Kay Fun Patches is a UK supplier of this type of patch. Framehuggers, is a supplier based in the USA, and Patch Pizazz, is a supplier based in New Zealand.
The main disadvantage is that the child can remove the glasses and patch themselves. The advantages are that this type of patch will not irritate sensitive skin nor will it be painful to remove. Another advantage is that you can choose different designs – you could even get creative and make your own with some felt! For an online tutorial on how to make your own patches see Lucykate crafts. These patches are also better for the environment than the disposable type, which you may wish to consider.
It is also possible to buy a ‘pirate-style’ patch which has an elastic strap that goes round the patient’s head. These are usually made of fabric. These may not be suitable for younger children as they can easily remove the patch themselves or pull the patch down so that the elastic is around their neck.
How long will my child have to wear a patch?
This depends greatly on the individual case. A child who had a partial cataract which was removed early is likely to have better vision in their amblyopic eye than a child who had a dense cataract for a long time. This is because the more the brain uses the eye, the stronger the connections become and the better the vision becomes. So unfortunately there is no clear answer, although it has traditionally been felt that the benefits of patching are greatest in patients under 10 years old, and you could expect anything from one hour a day to ‘all waking hours’ or ‘all waking hours minus one’ – typically 4 to 6 hours a day. Your pediatric ophthalmologist or orthoptist will monitor your child’s progress and adapt the patching time according to how their vision is developing. It is often said that patching is as much an art as a science – that is, there is no right or wrong amount of patching, so it depends what your ophthalmologist or orthoptist tells you.
Alternatives to Patching
In recent years there have been several developments in the treatment of amblyopia. Some doctors now prescribe atropine eye drops in the stronger eye, which forces the brain to use the weaker eye. This is not really an option for an eye which has had a cataract removed, since the difference between the eyes is likely to be significant, and the atropine will only blur the good eye, making it suitable for cases of mild amblyopia only. There is also an opaque ‘black’ contact lens which is designed to do the same thing as a traditional patch – block out the light from the stronger eye – however the majority of doctors prefer to stick with the traditional kind because inserting a contact lens carries a risk of infection. Your ophthalmologist should be willing to answer any questions you have about patching.
Support with Patching
Patching is difficult, however long you have to do it for. Parents are carers are likely to feel very isolated, as they may not know anyone else going through anything similar. Children naturally do not enjoy wearing the patch and it may be near-impossible to get the patch on and keep it on. In some cases, parents and carers resort to specially made ‘arm restraints’ to prevent a child from taking their patch off. Older children will feel self-conscious, especially if they have to wear the patch to school. It is important to remind the child often of the reasons for patching – to improve vision – and that the more they wear it now, the sooner they will be able to stop wearing it.
Parents may like to try reward charts, listening to music, planning fun activities to do while wearing the patch, distracting their child, for example by a change of scenery or a new toy (or of course good old-fashioned bribery).
Some links to web resources offering support for parents/carers and children:
1. Opticlude is a brand of adhesive eye patch. Their website offers games for children to do while patched, and you can download sticker charts and order free stickers and transfers to decorate patches. They have written an informative factsheet on Engaging your Child.
2. Website of the company Orthoptic Supplies, based in the North-East of England. Includes large free ‘reward’ posters where you can stick your used patches – various designs including Syd the Snake, Princess Rebecca, Danny the Dragon, Freddie the Fish. Look for ‘Motivational Products’ on the website.
If you would like to suggest any more useful resources, or if there is any information about patching which you feel is not covered here, please let us know! We value your feedback.
Author: Lucie, parent
This article has been checked for medical accuracy by Miss Isabelle Russell-Eggitt, Consultant Paediatric Ophthalmologist, Great Ormond Street Hospital, London