The goals of patching for amblyopia are to:
improve the vision in the poorer seeing eye, and
obtain the best possible vision in each eye.
Patching of the better seeing eye will help to stimulate the brain to improve connections with the poorer seeing eye.
Should the patch be worn when sleeping?
The patch should not be left on during sleeping hours at night. It may be handy to leave the patch on during naps in the daytime.
What types of patches can be used?
There are several patches that can be purchased. Ask about the patches in the clinic before you leave. Be aware that some of the adhesives are better than others for your child’s skin. Look for patches in different sizes. If your child wears glasses, some styles and sizes of patches will fit better under the frames than others.
When putting the patch on, firmly press the adhesive part to your child's skin to ensure a good seal. If a child peeks around or through a spot where the patch doesn't stick to the skin, the patching will not work as well. This is why we do not want you to use the black cloth tie-on or “pirate” type of patch. They don't fit the face well and allow the child to peek. They also move around under glasses. Some parents construct homemade patches out of colored, printed paper or cloth. If you choose to try this, make sure the patch fits around the eye snugly and does not allow peeking.
Will my child have any skin irritation with the patch?
Sometimes children will have red and sore skin where the patch is worn. The best way to avoid this is to use care when you remove the patch. Do not pull it off quickly. Sometimes, your child may prefer to rip it off. This can often pull off a small layer of skin causing the spot to get raw and sore in a few days. Sometimes children have skin sensitivities to the adhesive in the patch.
If you suspect this, try another brand of patch or make a patch and use non-allergic tape to put it on. Also, a large patch can be cut to a smaller size to fit a small child's face. There are ointments or other treatments that can be used if this becomes a problem for your child. Call the clinic and discuss this with one of the staff.
What problems can I expect with getting my child to wear the patch?
At first, it is common for a child to resist wearing the patch. Your child may not like to have the best-seeing eye covered up. A child often cannot understand or accept the reason for wearing the patch. The child realizes that vision is better without the patch on. This can be very frustrating for parents. It can be tempting to give in to the child. But, each time the patch is taken off, the goal of improved vision in the “lazy” eye is delayed.
It is important that you realize that you are not alone in carrying out this treatment. Talk over your problems and successes when you come into clinic or call and talk with one of the staff before your next visit. The staff can offer ideas to help you with the problems you are facing with your child. In time, most families find that the patching routine becomes easier and does not interfere with daily life.
Strategies for Success
Depending on the age and personality of your child, there are some strategies for success you might wish to try. A reward system works well for some children; some like a sticker for each day the patch is worn well. Some older children like to see their patching schedule on a calendar and want a star placed on each day the patch is worn well. Others like to color or draw on the patch before putting it on.
If the child is in school, his teacher needs to know about the value of patching, as well as the temporary limits of vision.
It is best for parents to be firm, but kind as they enforce patching. Often children will “test” their parents by taking off their patches again and again. Early in patching therapy, a child needs to learn that he or she will not succeed in taking off and going without the patch. This may mean taking one full day to stay with a toddler to be firm about wearing the patch and to replace the patch right away if it is removed. Spending extra time reading or playing with your child will show him that he can see and play with the patch on. When parents are consistent and firm about patching, a child will most often comply by wearing the patch.
Who to Call with Questions
UWHC Pediatric Eye Clinic:
(608) 263-6414, 8:00 a.m. – 4:30 p.m., Monday – Friday.
Nights and weekends: this number will give you the hospital paging operator. Ask for the Eye Resident on Call and leave your name and phone number with area code. The doctor will call you back.
If you live out of the area, please call: 1-800-323-8942.
If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.