By L. E. Leguire Ph.D., MBA
A recent article entitled “Why is Compliance with Patching Therapy for Amblyopia so Hard? by Dixon-Woods and Gottlob (Arch Dis Child 2006, p491-494) may be of interest to parents of amblyopic children undergoing patching therapy. The authors interviewed 25 parents of amblyopic children undergoing patching therapy for amblyopia and provide some insights into how to patch a child for amblyopia.
The authors found that parents must be the managers of the patching therapy and decide whether or not to follow the prescribed therapy with the associated stress of placing a patch over the child’s good eye for hours at a time. Parents found patching therapy particularly tough to do in the initial treatment period and things got easier once a routine was established. At least with older children (4 years or older), explanation, rewards, changing the patch to meet the needs of the child and enlisting the help of others (e.g., school bus drivers, teachers, older sibs, friends of the student) helped with the patching therapy.
With older children, one should never dismiss the value of explanation to the child in language that s/he understands. Half the battle is won if the child “buys-into” the patching program. Setting clear objectives with rewards for good patching behavior also seem to help. This is where routine comes to play: By patching the same time of day for the same amount of time and with some immediate reward, something the child enjoys, goes a long way in getting the child to wear the patch for the required time. Also, if the child has TV or Video game play time for, say, 1/2 hour, the parent could lengthen the video play time to one hour if the child plays the video game with the patch on the good eye.
Of course, follow-up visits to the eye doctor are also reinforcing if there is improvement from one visit to the next. If parents don’t see improvement in the child’s vision they’re less likely to follow the doctor’s recommendations. Also, the parents have to trust the doctor and respect his/her authority on the subject; otherwise, the parents are less likely to follow the doctor’s instructions. Eye doctors and their staff must convey to the parents the importance of the patching therapy and the need to follow directions. Further, parents must realize that sometimes patching therapy is very long and may require years of therapy including patching or the use of eye drops to dilate the good eye. Dilation causes blurred vision in the good eye and forces the child to use the amblyopic eye for seeing more clearly.
It may be important to note that in a study of patching therapy by Leguire and colleagues at Columbus Children’s Hospital, it was found that parents, on average, patched only about 50% of the time suggested by the eye doctor! Why? This was answered by another study by Dr. Leguire and colleagues who showed that patching therapy for amblyopia is hard and causes family stress and also causes psychological trauma to the child. Bottom line, patching therapy is very hard to accomplish and parents have to be committed to the therapy even when faced with a crying child and a long term commitment.
A lot of parents will alter the plain and boring patches used for patching therapy to custom and tailor the patches to the child. Some children really like stickers (cartoons) on the brown eye patches while other children might want to draw (or have the parent draw) something interesting on the patch. Some children prefer the patches that fit over glasses while other children might want a more standard “pirate patch” (black patch with string/band around the head. Other children prefer patches with differing colored images. Bottom line – children with be more willing to wear a patch they like than wear a patch that they don’t like. The patch should look “cool” and be something that the child likes.
Family members, friends and fellow students also play a vital role in determining whether or not the child follows patching therapy. Early-on the parents need to talk with the other family members of the importance of the child wearing the patch. Under no circumstances should sibs or other family members make fun of the child for wearing the patch.
Teachers also play a vital role in the patching therapy. While many eye doctors try to avoid having the child wear a patch during school hours, sometimes it is simply necessary to patch the child full time, which would include school hours. Under these circumstances, the parents need to discuss the patching therapy with the teacher and to have the teacher explain to the rest of the class the reason why the child has to wear the patch. In this regard, when children with amblyopia sign-up for the Ohio Amblyope Registry and when they’re undergoing patching therapy, the child receives the “Eye Patch Club” packet. The Eye Patch Club packet, from Prevent Blindness America, includes a lesson plan for teachers to discuss patching for amblyopia as well as stickers and a T-shirt for successfully wearing the patch. Just one of the many advantages of sign-up with the Ohio Amblyope Registry.
What about patching therapy for younger children, under four years of age? Stay tuned for that article at a later date.