I have a friend who runs marathons. She trains by completing 5, 10 or even 15 miles a day. While I have complete respect & admiration for her, I also know that my “training” blows hers out of the water.  See, I have to keep an eye patch on a toddler. For 10 hours a day. A toddler. An eye patch. 10 hours. Sure makes a 15 mile run seem like sitting on the couch. But, I am here to tell you while there is no t-shirt & medal at the finish line, what seems impossible is actually…possible!

Our condensed story: At 8 months old my son saw an optometrist through the infanstsee program, which provides free visits for 6-12 months olds (www.infantsee.org).  My aunt told me about it and since it was a free visit, we decided to go. Much to our shock (worry, anxiety, tears), he was diagnosed with a pediatric cataract! At 11 months, he started wearing an eye patch (2 hours a day). At 12 months his patch time was increased to 4 hours a day. At 13 months, we were at 6 hours. At 14 months he had cataract removal surgery & the patch time increased to 10 hours! With the addition of glasses at 15 months, it is safe to say the last 6 months have been a whirlwind. And by “whirlwind” I obviously mean “I am desperate for normal to return!”

Anderson after his surgery.

If your toddler is starting patching, be prepared. It’s hard.  I am saying this not to scare you but to make you realize you are not alone. While we have only been patching 6 months, we have definitely figured out some ways that make our lives much more routine. I will not say “easier” because no variation of the word, “easy” should ever be included in the same thought with “eye patch”.  Unless it is something like, “It is easy for me to hate the eye patch.”

When we first started patching, I was desperate for information. My son is my first baby & just when I started to get the hang of the whole mommy thing, BAM-an eye patch, glasses & surgery. What on earth? My frantic attempts at scouring the internet led me to discover that there is not a lot of info on toddlers and eye patches. Most of what I could find dealt with older kids & included words like reason, explain, bribe and charts. Since my son couldn’t even walk yet I knew I was dealing with a slightly different clientele. But, after much trial & error (and 6 months) we have made it routine, which is far from perfect but better than survival mode!

GETTING the patch on

Start with the right equipment:

• PATCHES: We tried Nexcare & Opticlude before my sister discovered krafty patches which quickly took over as our favorites. Because you are going to go through A LOT of them, it’s best to just order in bulk. What I love about these patches is they come in a variety of colors, they don’t irritate his skin as much as the others, they stay on pretty well & they can actually be reused if you can get it before your kid crumbles it up. Depending on the size of your kid’s face, you might have to trim the inside a bit.
• GLASSES: We use Miraflex glasses, which are 1 piece of malleable plastic. Perfect, perfect for a toddler. My son is fearless, active, a climber and into everything! I cannot imagine how many pairs of glasses or trips to the eye doctor we would have made by now if he didn’t have plastic frames. Numerous times a day (especially in the car), he will take them off and they don’t break at all because they are plastic!
• OTHER: Use Milk of Magnesia to create a barrier between the skin & the patch. We keep some in a travel size bottle because I made a mess every time I tried to dip the Qtip in the real bottle. Also, stock up on some kind of lens cleaner. Wal-Mart, Sams, etc. sells lens cleaner wipes for very cheap & we keep those stashed everywhere. Toddlers are sticky, dirty and touchy. The lenses will be so gross despite your best efforts. Anytime he takes them off, I clean them very quickly & then put them right back on. I try to keep them clean because he already is at a disadvantage with only having access to one eye!

The key to patch success is getting on the patch on while he is still disoriented in the morning. Don’t turn on any lights, TV, etc. until it is on. Give him his bottle/sippy cup & put a little milk of magnesia around the eye, let it dry for a few seconds & put the patch on! It has to be on before he is awake so he is used to it. Also, because young toddlers don’t understand, “close your eyes” yet, if his eye is open you will hear eyelashes all day as he blinks.

KEEPING the patch on

• So, once it’s on you only have 9 hours and 59 minutes to keep it on! This sounds like a nightmare & it will be at first. The key to keeping it on is thinking one step past normal toddler. All toddlers are active, independent & stubborn. As it is, you have to choose your battles so an eye patch definitely increases the intensity. Remind yourself that this is not a battle you can choose. You have to fight it. There is no option. So, you have to figure out how to make it happen! The key is A LOT of distraction. Whatever they are interested in, have it ready. Sing songs, look for trucks, read books….There is NO time away from your kid for awhile. The first few months my son was either holding my hand or sitting in my lap. He loves the vacuum so we just vacuumed a couple of times a day. You have to keep them distracted to they don’t remember it’s there! It will not be easy. Deal with it. Sounds harsh, but once you give in it will be easy to give in next time.

Anderson wearing his first patch!

• When it is time for it to come off (naptime, bath time), try to teach him that only Mommy or Daddy can remove it. He will still try to remove it, but it does help.  Always take it off from the inside to the outside because the outside skin is less sensitive.
• Don’t call it “patch”! It will consume your conversation with everyone you know and every time he hears that word, his little hand will shoot straight up to pull at it. We call our son’s patch the “cougar”. I have no idea why but it works. Once he figures that one out, we will switch to a new word.

I read a suggestion to keep water wings on him to prevent his arms from being able to reach his eye. They didn’t really work for us but he looked pretty cute!

STAYING sane

• This will almost push you over the edge. In the beginning, we tried filling in the patching chart to keep up with the hours but it quickly turned into a chronicle of how many times I cried that day, and I knew that was not a reliable outlet.
• Get frustrated. Get over it.  It’s unfair for your baby & for you. But, what is beyond fair, lucky even, is that you found out about the situation and are fixing it! He will react how you do, so don’t freak out when he takes it off. Take it from him and put it back on. Repeat. Repeat. Keep doing this until you win. The victory might only last 5 minutes until he removes it again, so start over. Your child’s vision is in your hands & you don’t want to explain to him one day that he can’t see because you let a 1 year old call the shots.
• Embrace it. Some people don’t make their child wear the patch in public because it is uncomfortable & prompts stares. This is where it is actually easier the younger they are because their feelings won’t get hurt. My husband has taught me that humor can cure anything. He once chronicled a detailed narrative involving an out of control parrot when asked about the patch.

• Remember, there is not much that is more challenging than keeping an eye patch on a toddler. But, you CAN do it! And, one day it will all be worth it when your kid looks at you with BOTH eyes to tell you he loves you!

(and a quick note: 3 years, 452 posts, over 3100 comments, and nearly 300,000 views from all over the world. Thanks for reading and commenting and submitting stories and being part of the community!)

So how about you?  Did you (do you) use bribery to get your child to wear his or her glasses?  If so, what have you used?  If not, what other strategies did you use to encourage your child to leave the glasses on?

Our early days of "tape patching." On vacation, sans napkins, apparently.

They’re not easy to spot, but if you look closely, you’ll find little ovals of Magic Tape jutting out from just about every surface in our home. Like an infestation of ghostly flat beetles, they peek out from door jams, edges of dressers and bookcases, and the side of our bathroom mirror. You’ll even discover them slapped to the dashboard of our car–because we take our occlusion to go!

For three to four hours a day, the right lens of Stella’s glasses is covered in a little patch of tape. I’ve been wondering if anyone else in the Little Four Eyes community is patching this way. I’ve never seen it mentioned, and have read here many times that doctors insist on the importance of full occlusion. At the risk of sounding controversial, I’d like to propose that 100% full occlusion, provided by the standard adhesive patches, is not necessary or “right” for every child with amblyopia. Stella’s story (so far, anyway) and solid research back up this premise.

Quite simply, translucent tape on the glasses lens over her stronger eye works for Stella. Her reaction to the adhesive-on-skin-style patch was so over-the-top. To me, it was heartbreaking and scary. She’d had an NG tube as a baby, a feeding tube that is taped to the face and goes into the stomach through the nose, so maybe old trauma was involved. Regardless, we all know that patching can be very trying for some kids and parents (though for some it seems to go quite smoothly), even without negative past experiences with adhesive! That said, I’m relieved to point out that Stella’s intense resistance is not why we patch with tape.

Backing up. When it became so very clear that the standard adhesive patch wasn’t going to work, I ended up rigging a simple foam patch–this “NoPeek Eye Patch” available on Etsy. I used double-sided tape to attach it to the inside of Stella’s glasses, after cutting it to fit better. She went along with this set-up amazingly well, and our problem was solved. But we wound up switching to the current tape method because it’s what Stella’s developmental optometrist (our third opinion, now our doctor of choice) prefers and suggests. The doctor explained that this way of patching lets light into the stronger eye, while still forcing the amblyopic eye to work more diligently and generally increasing the likelihood of full compliance to the prescribed patching regimen.

Again, I’m not suggesting that the tape method is suitable for everyone! I’m sure our doctor wouldn’t say that either. My goal is to simply highlight another option. As Stella has taught me time and time again, our little ones are all individuals and no way of parenting or patching or feeding or anything else seems to work for every child or family. And while I’m no expert, it seems reasonable to suggest that kids with really severe amblyopia may need total, absolute, no-light-of-day occlusion. However, I really wanted to throw this possibility out there for anyone struggling to achieve full compliance (patching for the full period of time required) with more traditional patches. Tape is a sound alternative, endorsed by our widely respected developmental optometrist, and supported by the results of a study of 84 ambylopic children, ”Optimal compliance for amblyopia therapy: occlusion with a translucent tape on the lens,” published in 2009 in the “Canadian Journal of Ophthalmology.” In short, notably better outcomes were achieved through use of tape, due to increased rates of compliance.

I bet you’re wondering, “But doesn’t she peek?” Sure, I have to say, “No peeking, sweetie!” to Stella on occasion. But I have bit of a system in place to help prevent peeking, and it’s made a huge difference. She gets 30 minutes of screen time in the morning, the main purpose of which is to kick-start patching. She knows that screen time means patch time. Period. For Stella, there is no watching of anything on a screen unless she wears a patch. And there is no peeking. If she peeks, it gets turned off. I just smile and say, “You know the rule: No peeking!” I never back down on this, and screen time/videos/TV is a compelling piece of leverage, so it’s been effective. By the end of her allotted screen time, she’s adjusted to the patch and we move on to vision therapy exercises (“eye games”) or other activities. As you all know so well, distraction is key. If she’s engaged, she doesn’t peek. She seems to forget all about the patch.

Long-term cooperation seems to be critically important for successful patching. To you parents of children who wear the adhesive patches as prescribed every day without constant resistance (meaning stints without the patch when it should be on) and battles, I recommend you do a dance of joy! And pat yourself on the back and pour yourself a glass of wine because, really, CHEERS TO YOU! In our case, the tape method helps secure cooperation, greatly decreasing the amount of conflict involved and increasing the probability of patching success. Stella’s showing improvement (as seen in her vision therapy sessions) and I trust our wonderful developmental optometrist, whose superb track record includes many patient success stories. Yet I have to admit that a bit of research gave me extra reassurance about tape’s effectiveness in treating amblyopia. With nagging questions and worries about Stella’s vision and treatment constantly poking at my brain, I appreciate any reassurance I can get. Something tells me you can relate.

Best of luck to all the other patching parents and kids out there. Whether using tape, foam, fabric or adhesive, I like to think of us as an extended family of sorts. A united force in the fight against amblyopia! I wish you peace and victory.

I just spent $1115.00 on lenses and frames for three members of our family and expect to buy our three-year-old’s first pair next month. We are not new to choosing from the long list of options when customizing glasses, though we had our own trials with differentiating which features and add-ons were important, cosmetic or just plain unnecessary.

First, ask questions. Go ahead and say that you need help deciding which options are important, the reasons for each and any cost or benefit.  Most opticians, optometrists, ophthalmologists, and even office staff want you to be genuinely happy with a very useful pair of glasses.  We often do this without our children present because it can take 30 minutes or so to make all your selections (even after deciding on frames) depending on how many pairs you’re buying.

Basics

We’ve learned poly-carbonate lenses are the way to go. These are also sometimes called Hi-index or safety glasses, and they are thinner than regular plastic. These are sometimes more expensive for adults, though usually no extra charge for people under 18 for the obvious safety reasons. They’re lighter weight, too, and they have built-in UV protection. Glass does resist scratching better, though. So, if you choose plastic, you’re gonna need coating.

Coatings

Scratch coating and anti-reflective/anti-glare are also worth it. Often, if you pay the charge for scratch-coating, your lenses can be replaced *for free* for up to one year. So, if you see even one scratch, take them in! Anti-glare is important for two reasons: 1) you seeing out and 2) others seeing in. First, anti-glare helps the glasses-wearer by reducing the ‘halo effect’ around lights. Second, with the coating, others see clearly through to your child’s (or your) beautiful eyes. This is especially nice in photos! Have you seen your reflection in someone else’s lenses? Anti-glare coating solves that, too.

Polarized and UV protection are most often associated with tinted glasses, aka sunglasses. We have chosen Transitions. (Photochromic is the generic term. There are many brands of this. Usually your office will offer just one. They all do the job!)  We love Transitions for several reasons. One is hyper-sensitive to light and these make a huge difference. It is also extremely difficult for a young child to be responsible for two pairs of glasses, and this eliminates the need. Their backup glasses are not Transitions, since they mostly sit in a drawer and are only to be used as a temporary replacement.

Extras

Some frames have wire arms or spring-hinges to build in some shock-absorbency. In my opinion, if you’re that active, get the sport glasses. We even have swim goggles that are prescription. (You gotta see the wall, right?) You can find these on-line at swim stores – as long as you know your prescription – and they are surprisingly inexpensive.

Service

Often, frames are under warranty for a year and almost every place will adjust and ‘tweak’ at no cost and as often as you need. Kids’ glasses can get bent just from running to you for a hug, so we are dropping by as often as once a week for adjustments.

Bottom Line

Our children are our top priority. Their vision and eye care top the list of health concerns. Few things are worn as often as glasses – think of the cost averaged over a year. Often, with all these options, my child’s glasses cost $300 or less. I have no stake in the eyewear industry, just in my kids.

Sources:

1. www.essilorjunior.com

2. The Seven Deadly Sins of Recommending Kids’ Lenses by Sharon Leonard, LDO, ABOC-AC, FCLSA

3. Victor Rosario, office manager
Coan Eye Care
Orlando, FL

Materials

craft foam, needle, thread, scissors, knife, tape, and the pattern

The following tutorial will demonstrate how to make a right left eye patch.

1. First cut out your foam pieces, add any extra fun pieces that you may want.  Remember, the more you add, the heavier your patch will be.  Linked here (Patch Pattern) is a pdf pattern of the main patch pieces.

2.  Assemble the pieces and hold them together with your fingers to make sure you are making your patch go the right way.  Sew your embellishments on to the rectangular section first.

3. Then, using a simple knot and a straight stitch, attach the rectangular piece to the main patch on the bottom.

4.  Fold the V in until the edges are touching and stitch through all 3 layers; top, front, and over the glasses pieces. (see, your stitches don’t have to be pretty!)

5.  Then place a square piece of tape on the triangular side.  This is to make the opening where the temples go through just a little sturdier.

6.  Using a knife or other sharp object, make a hole large enough for the temples to fit through.

And you are done =)    Well, with the patch part… here is how they go on the glasses.  I told Elliana that it was my job to put them on and off for the safety of the glasses.  These patches will fit snugly and I put them on slowly.  I made 2 patches and they each lasted me over a month when put on by a parent.

First slide the temples in between the main patch and the rectangular piece.  If you have cables, making sure the ends get in the smaller hole is a little tricky.  Those with Miraflex, I think you can take the band off.  If not, e-mail me and I will think of something.

Then pull through until the patch sits comfortably on the glasses.  I trimmed with my scissors around the nose piece so the patch sits inside of the plastic and a bit from the top so it rests comfortably on their forehead (thats why it is easier to make the pattern bigger and cut to fit).  If you have the regular nosepiece, then you could make a vertical slit for the nosepiece to fit into

.

Last and not least, have your child try their glasses with the patch on.  Make sure it is not rubbing or irritating, trim with a scizzors to make it a perfect patch for your child.

Almost forgot… we learned the hard way… DON”T use red or dark pink like my pictures.  When they sweat the color comes off and turns the skin pink.  I would use light pink, blue, white, yellow and other light colors.  If you do make a patch, please send me a picture to post.  I have a couple more that we have been using daily – pictures of them to come later!

I am about to embark on full time eye patching of my 2 year old son, to see if we can gain some improvement of vision in his left eye, this needs to be done 24/7 for one full week. We then have to go for an appointment to the opthamologist and hopefully will see some improvement, as his vision is declining rapidly in his left eye. Not looking forward to this, prior patching for short durations has resulted in tantrums, pulling patches off, wrecking glasses and refusing to open his eye that isn’t patched. Has anyone been through a similar process and have any tips?

To answer Darlene’s questions, I turned to Danielle Cruss (who goes by Miss Danielle on her website).  She is a Master-Certified Optician, who specializes in fitting and dispensing glasses for children.  She has a website that’s chock full of great information on children’s glasses, A Child’s Eyes.  Her website is listed on my page of resources for parents, but it’s such a good website, I didn’t think it would hurt to bring it up again.

One of the pages on A Child’s Eyes focuses specifically on the importance of getting glasses to fit correctly for a child.  The last three paragraphs talk about signs that you should bring your child’s glasses in for adjustments.  Specifically, marks on the side of their faces, and marks on the backs of their ears.  Marks on the side of their faces need quick attention (adjustments or new frames) as they can indicate that the frames are interfering with your child’s normal head growth.

I also interviewed Miss Danielle a year ago, and asked her for more information about signs that you child’s glasses aren’t fitting correctly, and here’s what she said:

If you notice any of the following you should stop by and have your child’s glasses adjusted:

• glasses that slip down,
• marks on the nose that are uneven or not symmetrical on either side of the nose,
• marks on the nose that don’t go away after about 5 minutes,
• glasses that are crooked on their face,
• any marks behind the ears.
• For the younger ones, if you notice any behavior changes, i.e.: doesn’t want to wear them, picking at their ears or rubbing their eyes, and watery eyes. [I can absolutely validate this one!  A while back, I noticed Zoe all of a sudden stopped wearing her glasses.  Turns out they were really crooked, and really messing up her vision - Ann Z]

The full interview is here, and is also worth a read if you missed it the first time around.  Miss Danielle really shared a ton of fantastic information.  I’m a little embarrassed to admit that I’d forgotten that I’d asked her about this in the interview until I went back to re-read it tonight.

I can answer Darlene’s last question all by myself – this evening I checked Zoe’s nose after she’d worn her blue glasses all day.  There were slight indentations on her nose, but no more red marks.   Hooray!