FAQ About Patching

Why do I need to patch?

Patching is a technique used to treat AMBLYOPIA which is sometimes called ‘lazy eye’. Amblyopia develops when one eye is used more than the other. This causes the other eye’s vision to be weak or poor. Some of the causes of amblyopia are misaligned eyes (strabismus), unequal focus between the eyes (refractive errors) or other abnormalities preventing the normal development of vision in one eye.  Often there are no clues to parents that amblyopia is present.

Patching the good eye forces the use of the weak eye and encourages the development of better vision.

Glasses may be prescribed to treat any focusing problems, but patching may still be required to treat the amblyopia. Surgery cannot correct amblyopia, and even though it may be performed to straighten the eyes, patching may still be required before and/or after surgery.

If amblyopia is not treated, it may result in a permanent and serious visual loss in one eye, it may affect depth perception, or it could result in a lifetime of poor vision if the good eye becomes diseased or injured. This will cause a life-long issue for the child.

Patching is sometimes also prescribed to help children control drifting eyes even when the vision is equal.

©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.

How long will I need to patch?

The amount of patching therapy required is different for every child.  In general, the younger the child and the earlier treatment is started, the less time it will take for the vision to improve. Some forms of amblyopia can be more severe and difficult to treat than others.

Your doctor may prescribe the patch to be worn full-time or for a certain number of hours a day. After vision has improved and stabilized in the lazy eye, patching is often continued and tapered slowly to prevent relapse. Worsening of vision can occur after patching is discontinued, which makes it important to have the vision checked regularly during and after treatment.

Some people recommend detailed or near work while wearing the patch to encourage use of the lazy eye and speed visual recovery. The best exercise, though, is wearing the patch! If the vision in the weak eye is extremely poor, it is important to supervise your child’s activities while being patched. Playing outside near streets or driveways is not recommended.

Unfortunately, not all children’s vision improves after a reasonable period of compliant patching and your doctor may eventually advise to stop treatment.

©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.

What kind of patches do I use?

ADHESIVE PATCHES

The type of patch we recommend for the best results are adhesive skin patches. A patch should fit firmly and comfortably on the skin around the eye underneath the glasses and should not allow the child to be able to peek around the edges. IMPORTANT!

Most adhesive patches are available in Junior, Medium, and Regular sizes. WE HIGHLY RECOMMEND using the regular size patches for all children over 2 years of age.

There are two commercial brands available at most drug stores or in the pharmacies of large department stores. Not every store carries each brand, so you may want to call ahead or talk to the pharmacist.

One excellent brand of adhesives are available for purchase in our office at manufacturer’s the cost. We do not mark them up. We simply carry them because we’ve found that it’s more convenient for parents to begin treatment immediately.

 

Orthopad (Eye Care and Cure Corp.)

  • hypoallergenic, latex-free
  • soft, fabric-like material
  • available in a variety of colors & patterns
  • specific patterns for boys or girls
  • 866-ORTOPAD (678-6723), www.ortopadusa.com

 

Coverlet (Beiersdorf)

  • stretchy, lightweight; contains natural rubber latex
  • flesh-tone color

 

Opticlude (Nexcare 3M)

  • paper-like material; hypoallergenic, latex-free
  • flesh-tone color
  • Additional brands of adhesive eye patches are available only by ordering directly from the companies.

 

MYI Eye Patch

  • hypoallergenic, latex-free
  • soft, fabric-like material, ultra-thin
  • available in variety of colors & patterns; color own
  • 800-544-4760, www.myipatches.com

Krafty Patches

 

Other Adhesive Alternatives

  • knee bandages
  • gauze pads with tape
  • homemade patches (instructions listed below)

 

ALTERNATIVE PATCHES

Fabric Patches for Glasses

Although the adhesive types of patches are recommended, some patients who experience skin irritation or compliance problems may benefit from the use of a different type of patch. Fabric patches that cover the lens of the glasses can be useful as long as the child is not able to peek around the patch. Be careful – kids can be very sneaky and creative! Many of these patches come in fun, assorted colors and designs.

Patch Pals

319-393-2620
www.patchpals.com

Framehuggers

877-327-7225
www.framehuggers.com

The Perfect Patch

877-505-1440
www.perfecteyepatch.com

Pumpkin Patch Eyeworks

www.lazyeyepatches.com

Luxeye Patch

866-678-6723
www.ortopadusa.com

Anissa’s Fun Patches

423-234-3404
www.anissasfunpatches.com

Eye Mateys

425-420-7707
www.eyemateys.com

Eye-Lids

www.eye-lids4kids.com

 

Homemade Patch Instructions

Patches to be worn without glasses:

  1. Cut an oval from a swatch of well-washed denim or other dark fabric that does not transmit light.
  2. Lay the fabric on a flat surface and place 3 1-inch wide strips of hypoallergenic or paper tape around the edges of the fabric leaving a triangle of fabric exposed.
  3. Trim the excess tape around the oval leaving enough to adhere to the skin.
  4. Make a few radial cuts in the tape on one side of the patch to conform to the nose.

 

Patches to be worn without glasses:

  1. Cut a rectangle approx. 3” x 1.5” out of brown or darkly colored construction paper.
  2. Round both corners on one of the shorter ends.
  3. Cut a slit into the middle of the opposite end approx. ¾” in.
  4. Grab one corner of the cut side with one hand (one tail) and one corner (2nd tail) with the other. Slide the two tails over each other until it makes a 90 degree angle with the rest of the paper. Staple or tape the tails together.
  5. Put a piece of double-sided tape on the inside in the middle of the patch.
  6. Place glasses on child, center the patch with the cup around the temple of the frame and stick on the patch.
  7. Trim paper as necessary, ensuring the child is unable to peek.

 

Pirate Patches

The type of patches that are held around the head by elastic are not usually recommended because of the ease with which kids can peek. However, some parents have had success with these and they may be a ‘last-resort’ option for those children who do not wear glasses.

Designer Eye Patches, Inc.

570-332-3130
www.eyepatches.com

Pastel/Colored Patches

800-348-2225
www.bernell.com

©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.

What if skin irritation develops?

Unfortunately, a few children do develop mild irritation on the skin from adhesive patches. Below you’ll find some tips to handle irritation.

TIPS

  • Make sure you are not leaving the patch on overnight.
  • Use a warm washcloth or sponge to wet the patch before removing. It is often the ‘pulling’ of the skin when taking off the patch that causes the irritation.
  • Switch to a different brand of adhesive patch.
  • Vary the size or position of the patch so that it adheres to a different part of the skin each day.
  • Cut various holes or sections from the adhesive portion of the patch. Ensure the patch remains secure and doesn’t allow peeking.
  • Try ‘pre-sticking’ the patch to clothing or your arm to reduce the amount of adhesive before applying.
  • Rub A&D Original ointment (not the diaper rash type) on the edges of the patch 15-20 min before removing. After setting, the adhesive will ‘melt’ and enable easy removal.
  • Apply a thin layer of milk of magnesia (Maalox or Mylanta) to the area of skin to which the patch is applied. Let it dry and then attach the patch to this area. This will protect the skin and enable the patch to come off easily.
  • Vary the schedule of patching to allow the skin to rest. For example; if you are prescribed 4 hours of patching per day, you could patch 8 hours one day with a break the next day.
  • Try placing gauze or hypoallergenic paper tape over the irritated area and then attach the patch to this rather than the skin. The skin under the tape may heal on its own.
  • Rub Aquaphor Healing Ointment (makers of Eucerin) or Cortaid (over the counter ½% hydrocortisone cream) on the irritation before bedtime to promote quick healing.
  • Apply 3M Cavilon No Sting Barrier Film to provide a protective barrier under adhesive (available at www.fresnelprism.com).
  • If all else fails; you can try an alternative form of patch rather than the adhesive type.

©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.

What if my child won’t keep the patch on?

Getting children to wear eye patches can be a difficult challenge and a lot of hard work. Successful treatment mostly depends on your commitment, involvement, and ability to gain your child’s cooperation. It DOES get easier – getting started is often the hardest part. Don’t give up too soon. There are occasionally times when patching continues to be impossible and you may have to accept that one eye will always be poorer than the other. It is always reassuring to know that you have done everything you possibly can with patching before accepting this.

TIPS

  • Routine (especially for little ones) is extremely important. Do not let a day go by that you do not make at least one or two patching attempts. Make an attempt, but do not persist to the point that your life or your child’s life becomes miserable. Just try again each day. The child will eventually understand that you’re not giving up. If the daily routine stops, the child has won the battle.
  • Treat any skin irritation early.
  • It may help to start slowly; high levels of patching early may induce frustration. Ask your doctor if you can gradually add an hour a day or week.
  • Use positive reinforcement and avoid negative reinforcement or power struggles. Allowing patching to become a battle is almost guaranteed to be a fight in which the child wins.
  • Use rewards.
  • Link patching with activities the child enjoys (TV, video games, etc.)
  • Try playing King or Queen for a Day; start on a weekend with adult supervision and fill the day with special privileges and attention to distract from patching.
  • Use a timer to indicate when the patch comes off. This makes the timer the ‘bad guy’, not the parent.
  • Consider having a rule that only parents or caregivers can touch the patch.
  • Try patching at school or daycare where there may be better supervision and distraction.
  • Be creative
  • Have your child help decorate patches with fabric paints, stamps, temporary tattoos, rub-on transfers, stickers, or other craft material.
  • Use the computer to print clip-art pictures directly onto patches.
  • Invent patching games.
  • Make a large reward calendar that the patch can be stuck to each day.

 

MORE ‘FORECEFUL’ MEASURES (discuss these with the doctor)

  • Use extra tape over the patch.
  • Use hand or arm restraints if necessary. Arm restraints allow enough arm movement for play but make it impossible to bend arms to reach face. The idea is to make the child connect the use of them with pulling off the patch. Just the reminder of the restraints often works. Remember, it is IMPORTANT to properly supervise children that are wearing any type of hand or arm restraints.
  • Hand Socks or Mittens with extra tape around the wrists
  • Inflatable Water Wings on the elbows
  • Specialized Pediatric Arm Restraint products:

 

SCHOOL TIPS

  • Talk to the teacher!
  • Present Amblyopia at ‘Show and Tell’; kids are less likely to tease if they understand the reason for the patch.
  • Make any necessary adjustments if vision is poor
    • Copies of books with larger print
    • Sit front and center
    • Enlarge printouts on copy machine
    • Encourage use of a white board rather than chalkboard to enhance contrast

 

OTHER OPTIONS

Another form of eye patching that is occasionally recommended involves using an opaque material on the glasses to cover the lens in front of the good eye. Unfortunately, this method makes it VERY EASY for children to peek over the glass and ‘cheat’, thus it is only good for very mild types of amblyopia or to maintain a level of vision once it is reached with regular patching. Translucent contact shelf paper and Satin Scotch tape are examples of things you can buy to cover the lens. Bangerter occlusion foils are a similar, specialized form of ‘cling’ patch for lenses. They are available in varying levels of opacity; ask your doctor or orthoptist for ordering information.

 

 

OTHER SOURCES OF HELP AND INFORMATION

BOOKS

My New Eye Patch by Nancy Chernus-Mansfield, M.A.
A resource book for parents with tips to achieve successful patching
Institute for Families of Blind Children.
323-669-4649, www.instituteforfamilies.org

Apple Patty Patches by Danielle D. Crum
The story of a little girl who undergoes successful patching therapy (ages 3-8)
Useful Q&A and activity sections at the end.
www.applepatty.com or www.fresnelprism.com

Blueberry Eyes by Monica Driscoll Beatty
The story of successful eye treatment from glasses and patching through eye muscle surgery.
www.amazon.com

Jennifer Jean, the Cross-Eyed Queen by Phyllis Reynolds Naylor
The story of a little girl teased about her crossing eyes and glasses
www.amazon.com

 

OTHER EDUCATIONAL MATERIAL

The Eye Patch Club; Prevent Blindness America
The ‘Eye Patch Club’ newsletter has tips and techniques for promoting compliance, stories from other children and parents, professional advice, a kids Page with puzzles and games, classroom Guide for teachers, Calendar and Stickers and a Pen Pal Form
800-331-2020, www.preventblindness.org/eye-patch-club-0

ORTOPAD USA has patching reward posters, the ‘Eye Patch Kids’ DVD, ortopad puzzles, ‘My Patching Booklet and memory games.
866-ORTOPAD (678-6723), www.ortopadusa.com/Products/Games-Books/Eye-Patch-Kids-DVD
©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.

Framehuggers Patching Pal Program has teddy bear patch pals and a tip guide and games.
877-327-7225, www.framehuggers.com

©2008 Riecke, OC(C). This was reprinted with the permission of Jillian Riecke, CO.