Lazy eye - how much improvement did your DC get with patch treatment?

[BirdyBedtime]

DD was diagnosed with a lazy eye earlier this year (refractive, not squint related). She started wearing a patch 8 weeks ago and had her first check up yesterday. She is doing well and had improved another line - hurray! (in addition to 2 lines improvement between getting her glasses in Feb and first seeing orthoptist in June).

But, we asked yesterday how far we have to go (as we hadn't really thought about this previously) and were told another 5 lines - at a line every 2 months this means potentially another 10 months of patching whereas at the first visit we were told it would be likely to be completed by Christmas. My question is whether it is really likely to achieve those 5 more lines and get equal vision in both eyes (with the bad one corrected obviously) - or will she probably plateau at some point.

DD is wearing her patch for 4 hours a day without too much complaint, but I can imagine that after months and months it might become a real chore.

I know there are a number of MNer who've been through this so would appreciate your experiences.

[DBennett]

The vast majority of improvement with patching occurs within the first 200 hours.

But the improvement curve is skewed towards the rear end, that is the the improvement tends to happen slowly at first and then speeds up some.

It is possible that your DD won't improve to match the better eye.

I don't know whether that is the target or the age/prescription etc have already moved the goalposts ton one line different (the most common end point) or driving standard/good spare eye status.

But certainly, you're estimate based on linear improvement is likely to be inaccurate.

[BirdyBedtime]

Thanks. The linear assumpation was based on the orthoptist saying they would usually expect a line of improvement every visit (which is 8 weeks). Interesting that one line different is the most common outcome.

Based on your 200 hour figure we may already have gained the majority of improvement as 8 weeks, 7 days a week, 4 hours a day equals 224 hours. They were really not willing to discuss what happens when she stops improving (although they said they'd consider her having reached maximum improvement when she had 3 consecutive visits with no improvement) which is what made me think that she might not get to no difference. At the moment she can certainly see with the bad eye when her patch is on, although she struggles with anything distant - her writing etc is OK but obviously not as good as with both etc. Maybe that is all we can hope for :(

[BirdyBedtime]

assumption obviously

[DBennett]

It's impressive that you managed that level of patching straight out of the gate.
Good work on both yours and your DDs part.

I think it's two early to give up hope of improvement.

The research on patching shows there are still gains to be made with 400, 600 and 800hrs, just that most children get most improvement before then.

And I wouldn't be concerned about the Hospital giving up too soon.
Recent data from one UK hospital trust indicates that anisometropic amblyopes got a mean of 1238hrs of patching.
In that study (and indeed in most) they also got better outcomes.

And, if I can I just make clear we're on the same page, I didn't mean that the one line difference was the most common outcome.

Unfortunately that is over-optimistic.

What I meant to communicate was that it is the most common target used for patching cessation.
Apologies if I was unclear.

[BirdyBedtime]

Thanks again (and for the clarification about targets - I'm being realistic and sort of think in my head if we can get down to 3 or 2 lines difference that will be a huge improvement from 20/200!!). God 1200 hours of patching sounds sooooo much but as you say if there is a chance of improvement. DD is 6 so understands the importance of wearing the patch and we have been very strict (timing the 4 hours on our mobiles) - she was wearing it from 3.30 to 7.30 during term, but at weekends and now we are on holiday she goes and chooses a patch first thing and wears it without complaint (until about 3 and a half hours when she starts asking how long to go). We made the decision if we were going to do it we'd do it by the book!

[jubilee10]

Ds2 now 13 was patched for 18 months between the ages of 4 and 5.5 and his bad eye is now almost as good as his good eye - which is not perfect. I believe this is fairly unusual as everyone appears shocked at the good response.

Ds3 (5) has been patched for the last 13 months, 4+ hours a day. I have never had any problems getting them to wear the patches and often go to pick ds up from nursery to find he is still wearing it 10 hrs later. I think the feeling is that his eye has improved as much as it it going to - we go back on friday and i'm not sure what will happen then.

Can I be really cheeky and ask DBennett if his eye will deteriorate if he doesn't wear his patch for a few days ie. on holiday when we are swimming a lot?

[jubilee10]

Can I also say I am finding it much harder to come to terms with this time round.

[virgiltracey]

DS1 was patched from 4.5ish to nearly 6. He had very little vision in his right eye when the problem was discovered and we felt awful since we hadn't even noticed since he compensated so well . He wore the patch from when he woke up until when he went to bed every day for the first year and then 2 hours a day for the final few months. His vision in his right eye has dramatically improved and there is not much difference at all now between his left and right eye although he will always need glasses. Patching really works and every child is different so I would urge you to follow the consultant's advice.

[virgiltracey]

jublilee if it helps we were told that not wearing the patch when swimming etc wasn't a problem at all (although I know that some children use those sticky ones for swimming- which DS1 absolutely hated)

[DBennett]

The general feeling is that a few days without a patch is fine.

A few weeks is not.

Just make sure you let your orthoptists know, they can't help as well with bad information.