• Should eye patching continue if my child’s eye dominance alternates between the left and right eye?


    Question:

    Should eye patching continue if my child’s eye dominance alternates between the left and right eye?

    We’ve never been told she has amblyopia in both eyes, but lately it feels both eyes have trouble maintaining dominance after patching. Switching back and forth must be tough on a growing brain. Is there an alternative method to bring the eyes together before it’s too late?


    Answer:

    Patching of the stronger eye for amblyopia helps the weaker eye develop stronger vision.  When vision becomes equal, patching is reduced or stopped.

    As is always the case, every patient has unique circumstances that guide the amount of patching, and that often varies based on the age of the patient.

    In some circumstances, physicians will "alternate patch."  This is when a patient is instructed to patch one eye on one day, then alternate to the other eye the following day.  This is sometimes used as "anti-suppression" treatment in children with intermittent exotropia (one eye crossing outward occasionally with normal eye alignment at other times).  Some physicians will use it in younger children to delay the development of binocular vision while the child's alignment improves.

    Although it can be hard to detect, most patients will always have some degree of ocular dominance—even without amblyopia— so it is not always a problem. The patching titration should really follow the visual acuity (sharpness) level, rather than the ocular dominance.