When to patch for amblyopia?

My niece has amblyopia (lazy eye) and her doctor is patching her good eye to treat it. She is supposed to wear the patch 6 hours a day. When is it best to patch? Outside play (large motions, long focal distances), inside play (dolls etc, fine motion, short focal distances), reading, TV, videogames, etc (medium to short focal distance, no motion, fine detail)?

You are not my doctor, etc. This is just my mom wanting to second guess what they are doing under doctor’s orders.

She has 20/400 on her bad eye so she cannot really see squat be it chasing a ball, reading a book or playing with dolls. It is all equally frustrating for her at the moment.

Also, does it matter if the 6 hours are continuous or piecemeal?

Great questions to ask her treating opthalmologist.

Difficult questions to answer without knowing specifics about her history, eye exam results, and related factors.

Patient education info here, with useful links: http://www.aafp.org/afp/20070201/368ph.html

Again, the specific aspects of the treatment depend on the individual clinical findings and need to be discussed with the treating physician.

Ask your eye doctor! But I will say that one component of effective patching is lots of hand-eye interaction. (i.e. ocular/proprioceptive feedback.)

In other words, don’t only let her watch TV for those six hours (not that you would anyway) but try to have her play with things, move things, bounce balls, etc. Supervise closely since she’ll have trouble seeing, and may very well remove the patch, depending on her age and temperament. And of course, keeping in mind that your niece will probably have trouble with direction and depth perception in addition to shape and form while patched, so of course please keep any area she’s in free of things she could potentially bump into/ trip over.

Yes, I know these are questions to ask her doctor. As I said, this is just my mom trying to second guess what her parents are doing. She sounded concerned last time we spoke and I told her I would ask around.

Her story, as far as I know, is that she got 20/20 a year ago in her regular eye check up at school and this year she got 20/400. Then she did the round around the doctors and they prescribed patching among others.

My question is general in nature. Not about her case in particular.

Does patching work better for physical activities, close manipulation, or reading/TV?

If the answer is “it depends”, then a brief overview of on what it depends would be nice.


I do recall from when I was being treated for amblyopia that my parents encouraged active stuff - things that will make your weaker eye work more all-around (focusing, tracking, etc), at a variety of ranges. Even things like board games or coloring were encouraged over reading or watching TV. Playing outside was considered great within limits - running around in the backyard was good, but my parents were understandably hesitant about letting me rollerblade or ride my bike or play softball when wearing the patch (which didn’t stop me until I took a softball to the head, and then I began to see their point).

Again, the point is to overall improve the ‘strength’ of the eye, including strengthening the eye/brain pathway for that particular eye.

I think if you pick any six hours during a day, any kid is going to experience an all-encompassing range of activities that will touch all possible scenarios.

My 5-year-old son has been wearing a patch for 6 hours a day since last July. In general, we have him wear it during one 6-hour session, but because he doesn’t want to be the “weird kid with an eye patch,” we take it off during things like pre-school, Sunday school, and t-ball league. I also have him take it off when he’s learning to ride his bike, go roller-skating, or when we see a movie.

And by the way, the patch seems to have definitely helped. I expect that at our next appointment, the opthalmalogist will say he doesn’t need to wear it anymore.

My daughter had to wear a patch for amblyopia, I think it was 3-4 hours a day. We had her put it on as soon as she got home from school. We were told that we should have her do close-focus activities while she was wearing it- reading, playing on the computer, drawing/arts & crafts, watching TV. Also, activities that allowed her to change her focus, but just not far focus.

After 6 months she had strengthened her eye enough that we were allowed to discontinue it.

Interesting. Thanks for the answers so far.

My mom’s big concern was about her running and jumping around with only one (blind) eye. My main concern was about the futility of reading with only one (blind) eye. I see neither was too far off. In any case, it is definitely true that 6 hours is a long enough window that per force she will be doing a bit of everything.

Can you read at all (or watch TV) with one 20/400 eye? That’s like trying to read a book 40 feet away!

watching tv may be difficult. books are easier 'cause you can hold them close to your face.

Snellen charts let you know what the kid can read from a fixed distance. In the same way that you can read the teensy-tiny letters at the bottom of the chart simply by moving closer to the chart, your niece may very well be able to read by moving the book closer to her eye. This will create a larger image on her retina that may make it clearer, although without knowing her exact refractive error and ocular history it’s hard to say for sure.

There are other things that often come along with amblyopia (nystagmus, for example, or problems with fixation errors, or other oculomotor difficulties) that may make reading difficult for her, particularly when using her “bad” eye. But it’s certainly worth a shot, unless of course she absolutely loathes it. Since you want to make her not want to tear off the patch in frustration, my first instinct is to do things she likes. If she likes reading, great.

By the way, I am not a doctor (yet, anyway.) I’m a third year optometry student. We do cover amblyopia, strabismus and other related things, but I haven’t gotten in the bulk of that coursework yet, or seen many amblyopic patients. So please keep that in mind and take my advice with a grain of salt.

Sapo, is that what her vision is correctable to in the weaker eye, or just the ‘base’ measurement? If it’s correctable past that, is there a reason why she can’t wear her glasses with the patch? (Just asking because my vision is pretty dire as well, and I recall being strictly told to wear my glasses when I was wearing the patch.)

The vision in one of my eyes is 20-400. It corrects to 20-200 with glasses. Even with the correction, I can read only the largest E on the eye chart. I can detect shape, color, and the number of fingers you are holding up if you are standing directly in front of me.

When I was about two years old, I had the patch. It was very frustrating. I would try to look out the sides of my glasses. Eventually a tiny hole formed in the patch and I could see a little out of the good eye. That was enough to keep me from developing the needed pathways between the right eye and the brain. That is something to double check for on the patch.

Even though he may have out-grown some of these toys, I would get him to play with toys that require hand-eye coordination. I would think that the more that he uses his binocular vision, the stronger that will make it. (That is part of my vision that I am missing.)

I am not an eye specialist or any other doctor.

While it’s true that once the “bad” eye is corrected, it’s a good idea to focus on binocular vision, at this stage the emphasis is on monocular visual activities with the amblyopic eye. Patching or some form of “penalization” of the good eye is absolutely necessary to correct or ameliorate the effects of amblyopia. If the kid, as you did when you were younger, tries to peek out of the patch or cheat in some way, atropine drops in the good eye are another possibility, although one of last resort because it always seemed (to me at least) cruel to essentially give the kid poorer vision 24/7. If it’s that or a condition that essentially renders someone permanently monocular, however, the drops may be the way to go. (But as always – are you tired of hearing this yet? :stuck_out_tongue: consult your eye doctor!)

That’s part of why (AFAIK) it’s standard now to use the single-use, adhesive eye patches. And even in older children to have a parent apply them to ensure that there’s no gaps to peek out of.

My brother-in-law (sister’s husband) told me that his daughter (my Niece) had amblyopia when she was younger but the doctor tried a newer treatment for her. He had her carry a parrot on her shoulder.

I swear. He told me that.

I’ve read that some people use a contact lens with a “wrong” formula on the good eye as a way to penalize the good eye that is both not permanent but also not cheatable.

I have no idea, to tell you the truth. I think it was 20/400 without correction but I have no idea what it is when corrected.