Patching for Children with Amblyopia (Lazy Eye)

Using patches to improve the vision in an amblyopic (‘lazy’) eye is a method known to be effective in treating this condition. Patching, also called occlusion therapy, is used to block the light to one eye to force the other eye to be used and therefore improve vision. 

Remember: Your child must wear any glasses prescribed for all of the time while patching.  Please make sure they are not looking over their glasses as this could interrupt with, and delay their treatment.  If the fit of the glasses is an issue, go to your optometrist for a glasses adjustment. 

Where to get adhesive patches from: 

• There are many different types of patches available locally in large pharmacies and online. Nexcare Eye Patches are great. All of these patches come in two or three sizes based on your child’s age. Refer to the individual manufacturer’s website for sizing information. The cost per patch ranges widely from 50 cents to $1.00. We recommend you investigate the options and decide what fits your budget and your child’s requirements. If cost is an issue, you can always make your own. 

Skin sensitivities 

• Many brands of eye patches are latex free and hypoallergenic. If you find your child is sensitive to one type of patch, try another brand. All adhesives have different formulations and some hypoallergenic patches may still cause reactions in some children. 

When should I patch? 

• There is no ‘right time’ to patch during the day. Whatever works for your family and school schedule is best. Making a routine is often the key to success, so children know what is expected of them, and when the patch goes on and comes off. 

Can I split up the number of hours of patching needed? Yes. 

• It has been shown that you can split patching time across the day without affecting gains in vision.

How long will patching treatment last? 

• This is a difficult question to answer as a lot of factors can affect improvements in your child’s vision. Treatment will continue until vision is equal or near equal in both eyes, or unless otherwise determined. 

• Usually a goal of 2 hours per day for moderate amblyopia.

• This all depends on your child’s cooperation and persistence with patching. 

What if my child hates wearing a patch? 

• Patching is prescribed because vision is significantly reduced in one eye. When a patch is placed over the ‘good’ eye, your child cannot see very well which often frustrates them. 

• As a parent, the more you persevere with patching and ensure consistency with treatment, the better your child’s vision will get and therefore the easier patching will become. 

• Children can also get discouraged from having to wear a patch on a daily basis, long term. By using some of the methods described below, it can help them persist with their patching routine. 

How can I encourage my child to patch? 

• A lot of families have had success with reward charts to monitor and encourage regular patching. Other things you can do with your child to motivate them include time on hand-held games when the patch is on, doing arts or crafts, reading their school reading book, dot-to-dot and colour by number tasks, and any other focused work that your child may enjoy to take their mind off patching. 

• It does not matter if your child needs to hold their book or game close while having their patch on. The treatment is still working, and your child is just adapting to the level of vision in their weaker eye. 

What happens after patching is stopped? 

• We will need to review and retest your child’s vision regularly, as we know that a significant number of children will get worse after stopping patching. 

• This can easily be monitored with regular orthoptic appointments. It is necessary that your child continues to wear their glasses full time. 

• Otherwise, there is a higher chance that their vision will reduce and more treatment will be required. 

Can patching make their ‘good eye’ worse? 

• It is possible that treatment is ‘too effective’, and that the previously stronger eye becomes the weaker eye. 

• It is very important to attend your appointments regularly, so that your child’s vision can be monitored and therefore the risk of this occurring is minimised.

Always be sure to review with your Optometrist or Ophthalmologist who prescribed patching to ensure vision in the 'lazy eye' is improving.

References

1. American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Amblyopia Preferred Practice Pattern®. Ophthalmology. 2023;130(3):P136–P178. 

2. Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Archives of Ophthalmology. 2003;121(5):603–611. 

3. Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003;110(11):2075–2087. 

4. Wallace DK, Lazar EL, Crouch ER III, et al.; Pediatric Eye Disease Investigator Group. A randomized trial of increasing patching for amblyopia. Ophthalmology. 2013;120(11):2270–2277. 

5. American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Amblyopia. 

6. American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Patching Tips for Parents.

7. American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Glasses for Children.