Amblyopia and Patching

What is amblyopia?

A common vision problem in children is amblyopia, or “lazy eye.” It is so common that it is the reason for more vision loss in children than all other causes put together. Amblyopia is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then “learns” to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it can cause permanent loss of vision.

What is refractive amblyopia?

Refractive amblyopia happens when there is a large or unequal amount of refractive error (glasses strength) in a child’s eyes. Usually the brain will “turn off” the eye that has more farsightedness or more astigmatism. Parents and pediatricians may not think there is a problem because the child’s eyes may stay straight. Also, the “good” eye has normal vision. For these reasons, this kind of amblyopia in children may not be found until the child has a vision test. This kind of amblyopia can affect one or both eyes and can be helped if the problem is found early.

Will glasses help a child with amblyopia to see better?

Maybe, but they may not always correct it all the way to 20/20. With amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “re-learn” how to see and the vision may increase. Remember, in some cases glasses alone do not increase the vision all the way to 20/20, as the brain is used to seeing blurry with that eye. For that reason, the normal eye may also be treated (with patching) to make the amblyopic (weak) eye stronger.

How long does amblyopia patching therapy take to work?

Although vision improvement frequently occurs within weeks of beginning patching treatment, optimal results often take many months. Once vision has been improved, part-time (maintenance) patching may be required to keep the vision from slipping or deteriorating. This maintenance treatment may be advisable for several months to years.

During which activities should patching be performed?

The particular activity is not terribly important, compared to the need to keep the patch on during the allotted time. As long as the child is conscious and has his or her eyes open, visual input will be processed by the amblyopic eye. On the other hand, the child may be more cooperative or more open to bargaining if patching is performed during certain, desirable activities (such as watching a preferred television program or video). Some eye doctors believe that the performance of near activities (reading, coloring, hand-held computer games) during treatment may be more stimulating to the brain and produce better or more rapid recovery of vision.

Should patching be performed during school hours?

We recommended that patching take place in a home-setting. Patching during school hours can be a socially stigmatizing experience. Furthermore, a parental or other family figure may be more vigilant in monitoring patching than is possible in the school setting.

What if my child refuses to wear the patch?

Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, etc. Children will often throw a temper-tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period.

What are appropriate goals of amblyopia treatment?

In all cases, the goal is the best possible vision in each eye. While not every child can be improved to 20/20, most can obtain a substantial improvement in vision. Although there are exceptions, patching does not usually work as well in children who are older than 9 years of age.

If you have any questions or concerns at any time, please do not hesitate to contact us.