Treating Amblyopia: Does Occluding One Eye Feel like Punishment?

Neha had been my patient for six months. She had amblyopia, also known as lazy eye, in her right eye due to a squint or strabismus. Initially, she was treated with only spectacle wear, which resulted in moderate improvement. The family and I had a long discussion about next steps, particularly occluding the left eye for two hours daily with a commercially available eye patch. This is an adhesive eye patch that is stuck on the area around the eye (the better-seeing eye). They seemed to grasp the importance of the treatment.

When they came for review three months later, I found no improvement in the vision whatsoever. I was puzzled. Neha’s parents were very clear that the treatment was done for two hours as instructed. Upon further clarification, I found that the patch was being stuck on the glasses. They also were honest that they couldn’t monitor the child for the whole two hours, and they did see the child peeking over the glasses off and on.

I explained to the parents that sleeve-like patches were available, which slide onto the spectacles and offer mostly good coverage, but they also needed monitoring. The parents chose to try the conventional patches glued onto the eye. After another three months, during the next visit, the vision remained unchanged.

Now, the parents admitted to not patching at all, as the elders of the family felt it was like ‘punishing’ the child. That was when I thought it was time for another session explaining exactly what patching does.

I sat them down and explained that patching is the mainstay of treatment for amblyopia, also known as lazy eye. By depriving visual input to the better-seeing eye, the eye with less vision is being forced to work, and thereby the vision slowly improves. It is a time-tested method and is, perhaps, the most common treatment for lazy eye worldwide.

Something that benefits a child and results in better vision and a higher quality of life cannot be considered punishing, even if it seems to upset the child. I advised them to offer the child incentives for patching, as well as short periods of television viewing and near games and activities during the patching process. I hope the importance has been understood, and we can finally expect some improvement in Neha’s vision.