Another look at full occlusion, and why we patch with tape instead.

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.

Advertisements

12 responses to “Another look at full occlusion, and why we patch with tape instead.

  1. Loved this post! No, we can’t all be perfect with all of these things that we are supposed to be doing for our child’s vision! I often wonder whether the doctors prescribing all these therapies have ever had to be the one responsible for implementing them day in and day out. For us, we don’t have problems with the adhesive full-occlusion patches but glasses are a huge battle. Trying to get those glasses on is impossible some days! The scotch tape suggestion is an interesting one. Please keep us posted on how Stella is doing!

    Like

  2. Does it leave any residue on the lens? I’d be worried about damaging the lenses (they’re sooooo very expensive to begin with).

    Like

  3. Thanks so much, Anne! I have absolutely wondered the same thing. When patching was first prescribed, by Stella’s initial ophthalmologist, they made it sound like no big deal. Spent about 10 seconds talking about it. “Here are some patches, put them on her stronger eye for 3 to four hours a day.” That was it! Our current doctor gave us helpful tips and acknowledged that it’s a process. What a breath of fresh air.

    Helene, no damage done whatsoever and we’ve been at it two solid months. The tape comes off cleanly. Our doctor uses this patching method widely and her judgment and sensitivity are solid… I couldn’t see her recommending this if it were a hazard to pricey specs. It works really well for us because I can slap the patch on in a second if she starts doing an activity that serves as vision therapy. And I can remove it in an instant without taking her glasses off.

    Like

  4. Our daughter Charlotte just turned two, has been wearing glasses for a little over a year, and has been patching one eye for about 8 months. Currently, we are using something like reusable tape on Charlotte’s glasses: “The original Swiss occlusion foil” by Ryser Ophthalmologie. Our pediatric ophthalmologist gave it to us. It’s a plastic film sort of thing. You cut it out the shape of the glasses lens, and it sticks to the inside of the lens by itself. You take it off each day and reuse it the next day. We have the full occlusion kind, but it comes in many different varieties. Again, no damage to the lenses, just like the tape. I imagine this might be a good product for older children who might be self-conscious about patching, because it just looks like the lens is fogged up a little bit.

    However, for an under two-year-old, we have found patching compliance to be a huge issue. Charlotte’s left eye is absolutely fine– good vision, no crossing. Her right eye is farsighted and crosses. So we can sympathize that she really resists when we block the vision of that perfect little eye. We tried the adhesive eyepatches– after a month or two she got old enough to remove it herself and throw it in the trash. One day she tried to eat it. Then we moved to a felt patch from Framehuggers, ordered online and custom made to fit her frames. She couldn’t peek or remove the velcro strap, so she started removing the whole glasses. She props them up on her forehead, which looks adorable and makes strangers ooh and aah, but of course it does not encourage her to put them back on. At least she stopped taking them off and throwing them. Also, we count ourselves lucky that she has not yet figured out how to remove the occlusion foil (we never let her see us putting it on the lens).

    Charlotte started patching 2 hours a day at 16 months and gradually moved up to “patching” 6 hours a day, of which we estimated we were getting 1-2 hours of actual patching. Glasses on, glasses off. Five more seconds on, then she would push them off. She is in daycare full-time, and the staff there tried their best to get her to wear her glasses, but with about as much success as we had at home, if not less. At our last ophthalmologist visit, we were surprised that the doctor did see improvement because we thought so little time was spent actually patched. And yet, Charlotte is still not using both eyes together as she should. So we now do an atropine drop in the good eye four days a week, with continued patching everyday for half her waking hours (which is still 6 hours– she’s a good sleeper!). Just recently, she has started accepting the glasses-with-patch better, and I’m beginning to think she finally understands the sentence “Charlotte, put your glasses on.” I feel like we are making incremental progress, and yet Charlotte will still probably need surgery this year. We feel lucky that she accepted her glasses easily at 11 months, and still does, even though the patching is such a struggle.

    I have a question for parents of other adorable “Little Four Eyes”s out there:

    Do you find that your child is more resistant to wearing glasses outdoors than indoors? Even with her Transitions lenses, Charlotte is more likely to take her glasses off outside. Is it because she’s climbing and running more, so she wants that good eye unblocked?

    Like

    • Have you had any better luck since then, K&J? I hope so. How frustrating! But how wonderful that you saw progress! I think the occlusion foil is very similar in effect to our tape method, and we are seeing much improvement too. We don’t see a difference with glasses wearing be it outdoors or indoors. Maybe a better fit would help them be more comfortable and move around less? I know, hard to remedy. Just a thought. I hope things have gotten easier and that she’s continued to come around!

      Like

  5. Hi, I`m Sara, new to Little four eyes, I have two girls age 9 & 5, our 5yr old has amblyopia & an inward strabismus in her right eye, her prescription for farsightedness is +5.50 right & +4.5 left. We have been patching for nearly a year, she made really good progress over the first 6mths then patching was dropped from 8hrs each day to 2, 8 weeks later was dropped again to 1/2 hour, in September her right eye had lost some vision again (heartbreaking!) we were also told she would never have binocular vision amongst other things, I frantically started to search te web, I found vision therapy, something I had never heard of before, I have managed to find a practitioner in the uk, we will be doing a 150mile round trip to see her, therapy starts this thursday, to cut a long story short! I wanted to leave a message to say how happy I am to have found little four eyes, reading about Stella, her progress and reading something positive about VT has been an enormous boost, it has been made VERY clear to me by the hospital here that I am wasting my time! I should accept that her vision is the way it is! As her mum, I can`t, I won`t not until we have tried, tried and tried again!! I wish you and Stella the very best of luck with all that your going through, maybe in a few months we too will have some good news to post.

    Like

    • Hi Sara, for some reason I didn’t see these comments until now. So sorry. I am dying for an update. How is vision therapy going? We think alike you and I! I wish you the very best of luck and for encouraging progress at your progress evaluation. 150 miles–what a testament to your dedication!

      Like

  6. Totally agree with your method of patching with Stella. That is also what we do for our son who did not like the sticky stuff on his face. Works really well for us!

    Like

    • hey Tracy! Thanks for chiming in! So happy to hear that it’s working for you, too! I don’t know about you but it was clear right away that adhesive was the enemy!

      Like

  7. Pingback: Vision therapy update: Stella’s first progress evaluation « little four eyes·

  8. Silly question- How exactly are you using the tape on her glasses? My son is 3 and patching is the next step for him. I feel so clueless! I’m just trying to gather info and your blog has been so helpful!

    Like

  9. Pingback: Patching Primer « little four eyes·

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s