If the child has a significant refractive error, be it long sightedness, short sightedness or astigmatism, glasses will be prescribed. The initial treatment for children with amblyopia and a refractive error, should be full time spectacle wear for 3-4 months. If, at the end of this period, the vision in the amblyopic eye has not started to improve, occlusion therapy in the form of patching, is recommended. If there has been some visual improvement with glasses alone, occlusion therapy is not needed, but will be started when there is no further visual improvement with glasses alone.
By putting a patch over the better seeing eye the child’s brain is forced to “recognize” the image from the amblyopic eye. This stimulates the development of nerve pathways between the amblyopic eye and the brain, so improving the vision in this eye.
Remember that if your child’s vision is poor in their amblyopic eye they may be clumsy when wearing their patch. The patch will also prevent any 3d vision that your child may have. Therefore they will not be able to judge distances as well when wearing their patch.
Some of the different types of patches include:
Patches applied directly to the skin, which are designed to be worn on the face underneath any glasses required. They are also available as hypo allergic patches for those with very sensitive skin. These are the most suitable patches for children with very poor vision in their amblyopic eye because it is harder for them to move the patch to try to peep around it.
Patches attached to the glasses, designed to be worn on the child’s glasses but it will be necessary to closely monitor your child to ensure that they do not try to peep by moving the patch sideways or pulling their glasses down to look over the top of the patch.
Some children respond well to this frosted tape applied to their glasses but again there may be a temptation to peep.
Persuading your child to wear a patch can be a challenge, especially if the vision in the child’s amblyopic eye is very poor and the child is objecting strongly. Unfortunately this is an area of treatment where there is no “quick fix” but it is also a brilliant opportunity to spend a great deal of time and enjoy playing with your child.
It is necessary to adopt a firm approach and probably easiest for everyone if the patch can become part of the child’s daily routine.
Patience and perseverance will be required and some children require a very structured approach to the patching routine eg. Setting the patch dose time on a cooking timer. Many children prefer to remove their own patch when the time is up.
Parents might like to start with a short explanation eg. Putting the clever eye to sleep so the lazy-bones eye can do some work.
It is probably best not to patch your child when they are tired as they are less likely to cooperate.
Often a routine of child gets up, washes face, glasses if required put on, followed by patch on and the teacher or nursery staff remove the patch at mid morning break or lunchtime works well for 2 or 4 hour doses of patching. Sometimes children will tolerate the patch better for someone other than their parents!
Many children respond well to daily star charts and charts such as these where they draw a smiley mouth if they have worn their patch and a sad mouth if they have not.
Parents may wish to consider a small reward at the end of each week if the patch has been worn well each day. Children may like to bring a picture that they have drawn or coloured in whist wearing their patch to their eye clinic appointments to “show and tell.”
When patching a baby or toddler, putting thick mittens on your child will mean that they are less able to easily remove the patch and / or glasses. The mittens can be tucked or sewn into the sleeves of a garment. Taking your child out for a walk in the pushchair with mittens and a patch will help to distract them and is an activity that most children enjoy. Sometimes patching at mealtimes when the child is occupied with their food can work. Be prepared that you may initially have to sit and play with your child constantly to ensure that the patch is not removed and in the early stages of patching they may be quite upset. As the vision improves in the amblyopic eye their acceptance of the patch should hopefully also improve!
The vision may improve more quickly if the child is “working” the amblyopic eye by performing some sort of close work and most children will enjoy choosing from a variety of activities such as reading (or being read to), colouring, making jigsaws or playing with electronic games.
Republished, with permission, from www.squintclinic.com.