Preparing to Patch
When patching a weaker eye is an option to help improve a child’s vision after retinoblastoma, parents often have many questions.
How is the eye patched, and is occlusion therapy still possible if patching isn’t? How fast will it work and will it fix a turned eye? Is it possible to patch too much, and why can’t patching wait until children are older?
We answer these questions and more here.
There are a variety of ways to achieve the same goal. Finding what works best for your child and family is important, and this can take some time.
- Adhesive eye patches that stick to your child’s face. These are commercially available at the chemist/drugstore, online, or you can make them yourself with Micropore tape.
- Cloth patch that goes on the glasses – homemade or available at chemist/drugstore or online, depending on where you live
Here are some links to ordering adhesive or cloth eye patches online:
What If My Child Can’t Wear A Patch?
Using an adhesive patch will not suit all children. They may develop a rash from the tape’s adhesive, or they may have an aversion to having a patch stuck on their face. If this is the case, there are other options:
- Atropine 1% eye drops: usually instilled once or twice per week
Atropine drops work by stopping the focussing ability of the better seeing eye at close range. This forces the poorly seeing eye to be used. However, just because the pupil is dilated does not mean the patching treatment is still in effect. After one drop, the pupil may remain dilated up to a week or more, but the desired blurring effect will wear off after a few days.
- Opaque self-adhesive plastic: “cloudy contact” applied to the glasses – on the side to be occluded.
Will Patching Fix The Eye Turn/Strabismus/Squint?
While the eye turn may cause the poor vision, improving the vision will not fix it.
It is really important to understand that occlusion is not designed to fix or straighten an eye turn or strabismus. In fact, occlusion therapy sometimes makes an eye turn a little more pronounced during the treatment.
How Quickly Will The Vision Improve and When Do We Stop?
With good compliance, a substantial improvement is usually seen in the early stages. Then the improvement can slow down, and the gains will be less dramatic. Patching tends to continue until the child has a few “cycles” with no improvement, despite changing strategies or treatment types.
Sometimes, the medical team may choose to taper off the occlusion therapy to prevent the vision dropping back.
In children who have very severe/dense amblyopia, their near vision may improve more quickly than distance vision. Improvement in vision encourages cooperation with treatment.
Sometimes, despite all efforts, there is no improvement, and the medical team, parents and child together need to discuss the time to stop.
In children with retinoblastoma, it is very important to be able to recognise as early as possible when this endpoint of treatment has been reached. The eye doctor can’t know when this point is reached if the patch is not worn for the prescribed number of hours.
How Much Is Too Much Patching?
Whilst patching is used to treat reduced vision, this must not be done at the expense of the other, good eye.
Your orthoptist/optometrist/ophthalmologist will give you instructions of how long you need to keep the patch on – do not do more than has been prescribed. They have considered your child’s age, how severe the amblyopia is, and their response to previous treatment.
This is especially important in children with retinoblastoma, as their treatment should not be at the expense of the best possible vision in the eye with most potential.
Why Can’t We Wait Until My Child Is Older And Can Understand Their Need To Wear The Patch?
A child’s visual system is constantly developing. There is a specific “window of opportunity” in which the best improvement can be achieved. Although emerging evidence indicates that some improvement may be obtained in older children, the best vision recovery is achieved if treatment occurs before 7 or 8 years of age. Visual needs of an older child are much greater, and the impact or inconvenience of treatment may be greater too.
Listen to a podcast interview Sandra recorded in 2020 with the Australian Royal Institute for Deaf and Blind Children, in which she discussed occlusion therapy in a general context, including tips and tricks for parents.
This is indeed true. Your child has endured a lot of treatment, none of which was pleasant. Of all the treatment and interventions, patching therapy is the least invasive and physically painful, and with some careful planning, may provide some good results. However, among all the treatments they endure, this one should be considered as complimentary rather than essential to cure. If it causes too much difficulty or distress, consider whether the potential benefits are justified.
Discover ways to help your child be successful and enjoy their patching experience in Part 3 of this guide.