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.