Patching (Occlusion)
Patching is a method of managing amblyopia which consists in temporarily covering the better-seeing eye, so that for that time the child looks with the weaker one.
The idea is simple: the eye that the brain pushes into the background day to day gets a chance to work. The patch therefore always goes over the stronger eye — parents sometimes find this surprising and it is worth explaining straight away.
Patching is used only once spectacle correction alone has proved insufficient, after a period of several months of observation in properly fitted glasses. The recommended time is usually two, four or six hours a day, depending on the depth of the amblyopia, and it is shortened as things improve. The schedule is set by the ophthalmologist or the orthoptist — it is not a decision made at home.
A few things worth knowing.
The risk of so-called reverse amblyopia, that is, of vision in the patched eye getting worse, is very small when the correction has been properly fitted.
The type of activity during patching has not been settled — near and distance activities were compared and no difference in the rate of improvement was shown. This does not mean, however, that the eye should do nothing in that time: the whole point of patching is that the uncovered eye is used.
Stopping does not happen overnight. It is done gradually, over two to three months or longer, because of the risk of regression.
Patching has an end point. When visual acuity stops improving at two consecutive check-ups, the level reached is taken as the target one. Continuing to patch despite the lack of improvement is described as persistent therapy and is not recommended.
Patching is management conducted by a specialist — ocu•vio does not conduct it, does not set the schedule and does not replace check-ups. What a child does during patching is decided solely by the supervising person.
Frequently Asked Questions
Which eye is patched?
Always the better-seeing one. The point is that the weaker eye, pushed into the background by the brain day to day, gets a chance to work.
How many hours a day does patching last?
The recommended time is usually two, four or six hours a day, depending on the depth of the amblyopia, and it is shortened as things improve. The schedule is set by the ophthalmologist or the orthoptist.
Does anything specific have to be done during patching?
Near and distance activities were compared and no difference in the rate of improvement was shown. What does matter is that the uncovered eye is used — the point is not for it to do nothing in that time.
When does patching come to an end?
When visual acuity stops improving at two consecutive check-ups, the level reached is taken as the target one. Stopping is done gradually, over two to three months or longer, because of the risk of regression.
Can patching make vision in the better eye worse?
The risk of so-called reverse amblyopia is very small when the correction has been properly fitted.
Related concepts
Source: Polish Ophthalmological Society, Section of Paediatric Ophthalmology and Strabismus, Wytyczne dotyczące postępowania w przypadku niedowidzenia u dzieci [Guidelines on the management of amblyopia in children], 2021.
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