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Date issued: August 2020  

For review: August 2022

Ref: C-418/SP/REI/Amblyopia and patching

PDF:  AMBLYOPIA final September 2015.pdf [pdf] 173KB

What is Amblyopia?

Amblyopia is an underdevelopment of vision in infancy and early childhood. This occurs because the vision-sensing part of the brain (visual cortex) has not been stimulated sufficiently and has therefore failed to develop normally. Therefore intervention is needed to allow for normal visual development.

Amblyopia can be caused by a squint, a need for glasses or a form of vision deprivation. Although amblyopia usually affects only one eye, it can affect both eyes. 

 

What are the symptoms of amblyopia?

Amblyopia often goes undetected due to this very commonly having no symptoms. Unless the child has a squint or other obvious abnormality, there is nothing to suggest the presence of amblyopia to even the most perceptive of parents. The child accepts having one eye with better vision and one eye with reduced vision as being a normal situation. Amblyopia is detected by testing vision in either eye separately.

 

How does occlusion treatment work? 

Occlusion treatment (patching) is used to stimulate the eye with reduced vision to allow the eye to work on its own. This encourages the development of the nerve pathways from that eye to the brain.

The patch is worn over the eye with better vision and the amount of time the patch must be worn is decided by the orthoptist, and relates to the extent of the visual problem. This is decided using researched guidelines to allow for evidence based practice.

If patching is implemented early on, a good level of vision can be achieved. When patching is started in an older child, it can be more difficult to achieve good level of vision¹.

In some cases an eye drop can be used as an alternative to the patch. Atropine drops dilate the pupil and blur the vison in the eye with better vision. This encourages the eye with more reduced vision to work independently and therefore improve the sight in this eye. This will be suggested by your orthoptist if appropriate for your child².

Benefits of occlusion treatment

• Increased job prospects in the future, e.g. surgeon or pilot.
• DVLA standard for driving a car is a minimum of 6/12 vision in at least one eye.
• Better experience of depth perception (3D), if binocular.
• In case any damage occurs to the eye with better vision at any time, there would be reassurance that there is still good vision in the remaining eye.

Will glasses help?

Any child found or suspected of having amblyopia will have an appointment with the optometrist to see for any need for glasses. If this is the case, glasses will be given for full time wear to allow vision to develop normally³.

 

Tips

• Explaining the reason for patching can prepare your child for possible questions they can be asked.
• Playgroup, nursery and school are in a good position to support your child.
• It is important to make patching part of the daily routine.
• Encourage your child’s involvement when patching. You may need to distract them and encourage activities initially, for example using puzzles.
• Patching charts help to motivate children and record success.
• Be aware that the vision may be quite limited with the patch on, initially but children often become more accepting of wearing the patch as their vision improves.
• Sticky patches or material patches (over glasses) are available.

School Screening

Screening is done by trained orthoptists in schools at the ages of 4-5 years old as a part of the UK National Screening Committee. This will be to assess for any possible reduced vision or eye movement disorders.

 

 

References:

1. Holmes JM, Lazar EL, Melia BM et al. Effect of age on response to amblyopia treatment in children. Archives of Ophthalmology. 2011; 129(11):1451-7.
2. Scheiman MM, Hertle RW, Kraker RT et al. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial. Archives of Ophthalmology. 2008; 126(12):1634-42.
3. Cotter SA, Foster NC, Holmes JM et al. Optical treatment of strabismic and combined strabismic-anisometropic amblyopia. Ophthalmology. 2012; 119(1):150-8.

 For help or advice, contact Orthoptic Department:

01752439319

For further Orthoptic information in regards to amblyopia:

https://www.orthoptics.org.uk/patients-and-public/about-orthoptics/