Amblyopia or otherwise known as “lazy eye” is a condition of reduced vision caused by the inability to process images in the brain. The brain in the first few years of life learns to process visual information rapidly, so anything that interrupts this learning can result in amblyopia. For over 200 years patching has been the standard treatment for amblyopia. It is easy to prescribe but as we all know is easier than it sounds. Noncompliance represents a significant factor, in patching regimen failures. In children over 8 years of age 50% of noncompliance is common. There is usually a struggle in getting the child to wear the patch and even if you do get the patch on the child, there is a good chance the child is peeking or that he takes of the patch while the parent is not in the room. From the child perspective he is wondering why they are covering his better seeing eye, why are they making it worse for him to see. When you patch a child you are taking him from seeing pretty well to everything being blurry and not clear.
There are many different types of patching, each with its positives and negative. For one there is the Bandagepatch. It provides total occlusion, it is convenient and effective and it comes in different sizes. However the negatives are the cosmesis, and in some cases children have an allergic reaction to the adhesive. For adhesive patches children sometimes complain of skin irritation. For this reason some parents have used hypoallergenic patches. Topical applications are also available for use on the skin under the patch area, which can help reduce irritation. In Addition, you can cut or hole-punch small holes in the adhesive part of the patch, which will minimize the amount of skin in contact with the adhesive. If the area under the adhesive has become irritated, you can try taping gauze over a larger area than the patch would cover, then attaching the patch to the gauze. Another type is the Pirate patch (the clip on patch) the positives are that it has total or partial occlusion. It is cheap and easy to put on and take off. (And it can be part of Halloween costume). The negatives are that it is loose and moveable and it is difficult to wear with glasses. In Additions, it’s easy for the kids to peek out of the side of the patch.
Patching works but how do you get the child to wear the eye patch and for it not to be a fight every time the patch goes one? Here are some tips that you can use to help in the patching processes;
- Make sure the child understands that the patch is making his eyes stronger. Don’t say “you have to wear this patch” involve him so that he feels like he has an important role in this processes.
- That it is a special patch that only he can wear and nobody else. There are many different website where you can purchase different types of patches. The child can pick a patch that they want to wear. Or they can get one that is designed for them. Wearing a patch that they like goes a long way, than wearing a patch that they don’t like.
- Use positive language and say, “The patch stays on until 2:30.” Saying “Don’t take the patch off,” is like telling the child, “Don’t touch that.”
- Consider having a rule that only parents touch (put on, take off) the patch (e.g., “When the patch is on, only Mom or Dad touch the patch.”)
- Avoid power struggles around patching. Use a timer to indicate when the patch comes on and off. This makes the timer the “bad guy,” not the parent.
- Try a reward calendar, marking each time the child wears the patch as prescribed.
- Activities that require active participation are fun and encourage your child to rely on sight, without any help from their ears. Activities that use fine motor skills (i.e., coloring, cutting, and pasting) are wonderful for encouraging use of the weaker eye.
- Spending 10 minutes with the child each time the patch is put on doing an activity that is fun for the child. This is about the length of time for the brain to “regroup” and begin using the weaker eye.
- Paint-with-water books Paint-with-water books are like coloring books. They are printed with dyes that become colorful with water. Children brush a damp paintbrush across a page and easily create colorful pictures.
- Beanbag toss games can be fun. Find five or six different containers (i.e., bowls, boxes, pots and pans) and set them in a line on the floor, separated by a few inches. Have your child stand at one end of the line and try to toss a “ball” (Ping-Pong ball, rolled up sock or beanbag) into each of the buckets. If they miss, have them try again until they are able to get the ball into each of the buckets.
- Reading is another wonderful way to pass time. As you read, follow the words with your finger, drawing your child’s attention along with you. Talk about the pictures and have him or her try to guess what might come next. Even very young children will enjoy and can benefit from looking at wordless books. Fun activities stimulate vision and make patch time easier for everybody. One-on-one attention may ease some of the difficulties associated with patching.