By Dr. Charles J. Bock

Patching Treatment for Amblyopia

Amblyopia describes an eye that appears normal with the exception that it does not see well. Although it is sometimes referred to as "lazy eye," amblyopia really represents a problem with the brain failing to recognize the visual signals it receives from the eye. The brain "turns off" the eye. This is called suppression.

Suppression of one eye, resulting in amblyopia, can happen for a number of reasons. One of the most common causes is a wandering of one eye. The general term for this is strabismus, but there are many forms of strabismus, including esotropia (an eye wanders inward, toward the nose), exotropia (an eye wanders outward), or hypertropia (one eye wanders upward). Whereas an adult with strabismus usually has double vision, the brain of a child is able to adapt by suppressing the eye, which results in amblyopia. Amblyopia may occur for other reasons; one of the more common is if one eye is significantly more farsighted or nearsighted than the other, resulting is such poor focus in the eye that the brain suppresses it.

Reasons to treat amblyopia

Early treatment of amblyopia is essential. Once amblyopia is diagnosed, prompt treatment provides for the greatest possibility of improvement of the vision of the affected eye. Delaying treatment significantly decreases the chance that vision can be improved: the older the child is when treatment is begun, the more difficult it becomes to improve the vision and the more likely it becomes that treatment may not help the vision in the affected eye.

If amblyopia is not treated, the eye will not see well, and the brain will permanently adapt to this poor vision. The result may range from a mild visual impairment to legal blindness in the affected eye. Depth perception is decreased in people who have amblyopia. They must wear protective glasses to prevent accidental damage to their only good eye. Additionally, there are some professions (including some government, law enforcement, and airline industry jobs) which require good vision in each eye.

How to treat amblyopia

In some cases, Dr. Bock may want your child to wear glasses for several weeks to see if these will be helpful, but in many cases patching will be needed. Some children may require patching but not need glasses, while other children may need both patching and glasses. Dr. Bock will explain your child's specific needs.

Patching consists of wearing a patch over the good eye for a prescribed amount of time each day. Wearing the patch over the good eye forces the brain to use the amblyopic eye, which helps to "undo" the suppression and improve the vision. Patching may be required full time (especially at first) if the amblyopia is severe or if the child is older.

Dr. Bock usually recommends adhesive patches, such as Opticlude or Coverlet. Coverlet patches have a stronger adhesive that is sometimes helpful for African American children, but that sometimes can be too harsh for children with fair skin. In rare instances, Dr. Bock may allow your child to wear a patch which fits over your child's glasses. Unfortunately it is too easy for children to peek around these patches and use their good eye, which defeats the purpose of patching. Black "pirate" patches should not be used.

Helping your child with patching

Some children are excellent patchers and need very little encouragement or explanation. Some do well at first, but become frustrated or lose interest after a few weeks. Others have a very difficult time patching from the beginning.

The most difficult time to patch is usually in the beginning. As you can imagine, covering the good eye in a child with very poor vision in the other eye can be confusing and frustrating for the child. Your child may have difficulty getting around for the first couple of days with the patch, and may bump into walls when walking. This difficulty is evidence that the vision is poor and needs to be improved. Once your child is through this initial period, which usually lasts 48 to 72 hours, navigation will be much easier. Please feel free to call Dr. Bock if you have any questions during this or any other time.

It is very important that the patch remain on during this period for two reasons. First, if the patch is removed your child will need to go through the adjustment period again. It is much easier to get through this difficult time once than to get half way through it several times before making it all the way. Second, it is important that your child realize that the patch must stay on. Compliance with the routine will be easier for your child if you are consistent.

Depending on age, your child may enjoy decorating the patch with stickers or markers, or may want to mark off good days of patching on a calendar. Older children may be motivated to wear their patch if together you set up a reward for good patching.

What to do if your child has skin irritation

It is very important to continue patching even if the skin becomes irritated. To help decrease irritation, you can paint Malox or Milk of Magnesia over the skin, allow it to dry, and then apply the patch. The adhesive will stick, but the skin will be protected. You may also apply Vaseline to the patch about 15 minutes before you plan to remove it. The Vaseline will soak through the patch and release the adhesive. It will be difficult to get a patch to stick until the Vaseline is removed, however, so this is not a good trick to use for children who are supposed to patch full time.

Full time patchers can wear their patch around the clock. It does not need to come off for sleep or bathing. One patch may last several days. By avoiding regular removal of the patch, the skin irritation is usually much less. You may apply Malox of Milk of Magnesia before placing a new patch if you see any signs of skin irritation.

What to say to others

Especially if your child is patching full time, you may find yourself in public being asked about your child's condition by strangers. Usually, a brief, honest answer is best. If your child must patch in school, it is important to let the teacher know that the patching is necessary and that your child may need extra help for a short time during the early stages of patching. Some teachers choose to discuss a child's patching with the entire class, and this often prevents teasing.

What to expect next

You will be given a follow up appointment for a check of your child's vision and progress with patching. If full time patching is needed, it is imperative that your child be seen as scheduled. Usually children who are patching full time may go one week per year of age between visits, so that a four year old child would be seen after four weeks of patching.

Once maximal improvement of the vision has been achieved (20/20 vision in the amblyopic eye or failure to improve on two consecutive visits despite good patching), the patch will be tapered. Patching cannot be stopped abruptly because there is a risk that the amblyopia may return.

If your child has strabismus, you may see that the previously good eye wanders some of the time. This is a sign that the vision in the amblyopic eye is improving. If the previously good eye wanders all of the time and your next appointment is more than one week away, please call our office to discuss whether the patching needs to be changed. Please wait to speak with us before changing the patching routine.

If you have additional questions

Please feel free to contact our office 503-656-4221 at any time. Our goal is that you understand completely your child's condition and treatment.