What is amblyopia?
Amblyopia, sometimes called lazy eye, happens when one eye is used less than the other from birth to seven years of age, which leads the brain to prefer the better eye.
Patching treatment (occlusion therapy)
The main treatment for amblyopia is to restrict the use of the good eye. This then forces the affected eye to work. If this is done early enough in childhood, the vision will usually improve, often up to a normal level. The common way this is done is to put a patch over the good eye.
The length of time an eye patch is used, and how long it should be used each day can vary. It depends on the age of the child and how bad the amblyopia has become. Patching can be required for a short period of time (for example one hour per day) or several hours per day. The level of vision and the amount of time patching is required, and the need to continue patching treatment will be reviewed regularly.
Sometimes eye drops or special glasses are used to blur the good eye instead of using an eye patch. Again, this forces the child to use the amblyopic eye to see.
Implications of patching treatment
It is important to remember that the good eye is covered, meaning that the child has to use the weaker eye to see.
This means that they may have trouble with close work and seeing fine details. They may also have poor distance vision, meaning that seeing the board, teacher demonstrations or finding their friends in the playground
Children undergoing patching treatment will have reduced binocular vision. Normally, both eyes look and focus on the same spot. The brain combines the signals from the two eyes to form a three dimensional image. For those with a squint, the two eyes focus on different spots.
This means the child may:
- not be able to see properly in three dimensions
- need support with certain tasks such as catching a ball, going down steps or threading a needle as judging depth, distance and speed will all be difficult
- not be able to judge the height of steps
- not be able to each accurately for objects
- have difficulties judging how far away an object is
- be more likely to bump into things or fall when in unfamiliar places
- miss objects or people approaching as there will be reduced visual field on the patched side
What you can do to help a child wearing a patch
Whatever the child is doing, they’re stimulating the vision in their weaker eye. Distraction is a useful strategy to encourage the child to wear a patch.
It may be easier to patch when the child can focus on stimulating fun activities rather than learning something new that requires a high level of concentration and effort.
To help a child wearing a patch, you can:
- use a reward system with attainable short-term goals
- help the child understand why they need to wear a patch
- help other children understand why a child needs to wear a patch, you can also help the child explain to others if they’re asked
- give the child time to explore their environment including steps and heights
- keep classroom in a consistent layout as much as possible
- Allow the child to bring objects close to them or to get close to objects or books
- encourage the child to engage in fun activities while being patched
- provide extra supervision when in unfamiliar environments
- establish a routine: think carefully when the best time would be to patch, so that the child can engage in activities
- start with fun activities and once the child is more confident wearing the patch, you can try to have them wear the patch as much as possible whatever they’re doing
If vision in the weaker eye is very poor:
- provide books with larger print or enlarge some materials and books: books for young children often have large print and it’s useful to have an example of font size the child can see
- make sure the child is sitting close enough to the teaching focus to be able to see it, for example closer to the interactive white board or to the shared story book
Activities a pupil can engage in while patched include:
- games that involve drawing a line in between lines, like in mazes to find your way out
- dominoes where you match patterns or colours
- peekaboo games: find a picture hiding under flaps or somewhere on a page
- share a story book: if vision is very poor in the weaker eye, choose books with large bold pictures
- drawing, colouring and painting are good activities
- watching a video
- playing computer games or an iPad game
Transition between settings
- At transition times between setting, for example from nursery to school: Make sure staff in the new setting are informed about strategies in place in the current setting.
- Make sure you share any information and advice provided about the level of vision with new setting.
- Make sure staff have contact details of the pupil’s orthoptist.
- Establish a routine for patching that will work the new setting.
More information
- Strabismus and amblyopia in children | RNIB
- Lazy eye – NHS (www.nhs.uk)
- Amblyopia (lazy eye) | Moorfields Eye Hospital NHS Foundation Trust