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Eye Patches - hints please?

40 replies

merrygoround · 31/08/2004 22:14

I posted recently for advice on getting dd to wear her new glasses and it has all gone fantastically well. Now the patching has to start, and I have a horrible feeling that the stress of the glasses was nothing to what the next stage is going to be like....

She threw a wobbly when the doctor (who is lovely) tried to stick a patch on her eye - and having tried it out myself tonight I can only sympathise. I was really shocked to discover that the patch is not like a dressing up pirate one, but like a large sticking plaster! I've had a trawl throught the archived messages and learnt two things - one is that her eyebrows might come off with the sticky patches, and two, that there are other types of patch out there.

Can anyone give me any further advice? I would be so grateful. By the way, the doc suggested that it might be best if dd wears her patch full time for the 3 days she is at nursery, as she will be busy and distracted. Any extra time I can build in will be good too.

Thanks in advance.

OP posts:
merrygoround · 05/09/2004 21:39

Amblyopia?? Is that a squint? I didn't even know it had a "proper" name! What is your profession Woodstock? I was fascinated to learn from dp's mum that all 7 of her children had a squint at some stage, and three of them had operations to help. Dp's was very mild, but for ages I used to accuse him of being drunk because his eye had "gone funny" - I've learnt now that the squint comes on more when he is tired. Some of dp's siblings have had children with no squint, yet all three children of one sister have it.

Dd has found the patching very, very stressful. She has been hugely temperamental, over tired, and even regressed with her toilet training. On the first day I patched her she wanted me to hold her like when she was a little baby! I gave her the day off today and she was SO happy. I am going to keep using the sticky patches till her next appointment (in two weeks time), but if it continues being so hard on her I may well look at other patching methods. I was told by our local optician that dd's eye doctor is one of the top ones in that field in the country, so she should be aware of all the research. It would be good to have a greater understanding next time I go, especially if I'm going to ask to change the patching method.

OP posts:
lou33 · 05/09/2004 21:44

Can I ask how bad is the squint? Being nosey more than anything, but ds2's was about as bad as it could be when they operated on him. It's about halfway on their prism thingy now, but looks so much better, I barely notice it.

merrygoround · 05/09/2004 22:08

Lou, I have no idea, as I don't know how they measure these things. All I can tell you is that her "poorly" eyeball was sitting right in the inner corner of her eye most of the time before the glasses went on. The only other factual thing I learned was that she was having to work 5 times harder than a "normal" person to focus in the distance, and 8 times harder to focus up close. But I don't know if that makes it bad, average or good. What age did your ds have his operation? And how long had he been patched?

I'm afraid I know very little about how eyes work, as I still can't understand how this patching thing works. I know that the eye is lazy and needs to work in order for the brain to send signals to it the same as it does to the good eye, but I don't understand how the eye actually gets straightened out. Is it possible that patching can bring up the vision but the child is still left with a squint? Is that where the operation comes in - ie to deal with it more on a cosmetic level?

When I have a bit more energy I think I'd better do a bit of searching the internet for information. Every time my mum asks me a question I start off thinking I understand it and then realise that I don't!

OP posts:
lou33 · 05/09/2004 22:35

It can get really confusing can't it, esp when you spend a long time thinking about it! I noticed him develop a squint when he was 9, old, so took him along to the hv, who was USELESS. Denied he had a squint, but said she would refer him anyway. She forgot, so I waited about 4 months to get an appointment through. The eye docs said staright away that he needed glasses though. They tried that first to see if his eye would straighten, but it didn't. Interestingly, they said that although the squint was mainly in his left eye, he could swap it to his right eye. So in effect he was compensating by using one eye at a time, which meant the muscle wasn't that lazy, he just wasn't able to use both eyes at once. I'm told this is a good thing, as both eye muscles get used.

Like I said, wearing glasses alone didn't work, and after 6 months of wearing them (he started at 1), we moved house to a new area. The eye clinic there said he needed patching, for about 3 hours a day for 6 weeks, I think it was , to see if it helped. It did a bit, but he still had a v marked squint, and we figured he had so much to contend with as he grows up already, that if we could minimise any further chances of bullying or stress then we would.

He had his op in NOv last year,aged 2 1/2, in and out within 6 hours. His eye looked a bit red, and it made me a bit squeamish when he kept trying to rub it (they don't dress it afterwards), but he was really good after the first afternoon wrt touching it. In fact he recovered v quickly, and I could see an instant improvement. Like I said he does still have a squint, but they tend to undercorrect rather than overcorrect, but it is a huge improvement.

To do this they have to cut and shorten, then reattach the weaker muscle, makes my knees go quite frankly. I guess by patching they are making hte weaker muscle work more, hence strengthening it, which hopefully avoids the need for an op.

Has this made any sense?

Miaou · 05/09/2004 22:41

Don't worry Merry, I still feel like that about dd1's squint, I feel the whole thing rather difficult to understand! She is now 7 and will always have to wear glasses, but she was not offered an op (her eye didn't turn in that much, perhaps that's the reason why).

In terms of how bad her squint was, when we first went to see the eye department at the hospital, they held up a letter O the size of a large orange, about six feet away from her, and she couldn't see it at all with her bad eye!! Dh and I were HORRIFIED - we had no idea.

Re the patching - if you are still struggling with the stick-on patches when you go back to the hospital, you could always ask for a fabric one that goes over the glasses - even giving your dd the "power" of being able to choose which kind of patch she wears may encourage her to take to it.

Just realised, I am repeating myself from further down the thread, sorry.

woodstock · 05/09/2004 22:42

I am an optometrist in the States and have done a fair amount of work with children on this. Amblyopia is an eye that is not achieving optimal vision even with glasses. Sometimes a lazy eye will turn in (or out) and sometimes the child is not using it because of a vision problem but the eye stays straight, hence the parents don't know that there is a problem until a failed vision screening. Because of this I recommend an eye exam at age 3 1/2 to 4 for every child just to rule out such a problem.

Surgery can straighten an eye quite well, but even afterwards a child can have lowered depth perception and/or less than optimal vision, it just looks cosmetically better. The fact that her eye straightened with the glasses is very, very good. That means that she probably has "accommodative esotropia" (which is turning in due to farsightedness) and with glasses and patching may very well achieve normal vision in that eye as well as normal depth perception.

I would make a good effort to do this before doing the surgery as I think you have an excellent chance for success. The optimum time for visual development is birth to age 6 so you have caught this at a good time. Unfortunately, this is also a tough period to do patching as children can't really grasp the importance of it. I have had many adult patients lament that they didn't wear their patch.

It absolutely can be hereditary so I always recommend parents with this problem get their children tested at a young age. I am so sorry to hear that she is having a hard time with it. I know that makes the situation stressful on everyone. Try letting her decorate the patches and have certain coloring books, games, etc. that she only plays with when she is wearing her patch. Try making up a story about a princess with a patch or something like that.

I have emailed my colleague who is Chief of Vision Therapy at an optometry school here, about the article's author. I believe he is out of the office for a few days but will post the information as soon as I get it.

I know this is rather longwinded but I hope some of the information is useful to you.

merrygoround · 06/09/2004 10:07

Thanks Miaou, Lou and Woodstock. Sent dd off to nursery this morning with her patch, so we'll see how that goes. Although she threw a wobbly when I was about to stick it on her, I am getting the feeling that she is not quite as bothered by it as she would lead me to believe (IYSWIM). Once it is on she does seem to accept it - she tends to keep one hand on it, but lets go if distracted enough. So the main thing I am hoping for now is a clearer idea on optimum patching arrangements - half day/ 3 hours/ three full days, so as not to over burden her.

Woodstock, I feel very encouraged by what you have explained, so thanks again.

Lou, I think I was lucky that I went straight to an optician when I noticed dd's squint, and that he put me on to the children's clinic. Dd had been doing a lot of blinking even a year before, but I don't think at that point there was any real indication of anything wrong- I took her to the GP who said children often get into a habit of blinking and to ignore it and see if it went away.

BTW, for anyone who is interested, there is a book called Magic Glasses, which I got via Amazon, which features a cat who gets a patch as well as other animals with glasses! It is a really nice book. I've got quite a collection now. I think I will try to get dd to draw some glasses or perhaps colour in some cardboard ones or something, and I like the idea of making up a story too.

Thanks again.

OP posts:
woodstock · 09/09/2004 02:06

You're very welcome! I am still waiting for the link to the article for you.

Keep me posted on how things go and thanks for the book referral. I hadn't heard of that one.

frogs · 09/09/2004 08:46

Hi merry

It took me ages to understand the physiology of amblyopia as well, so I'll try and pass on some of how it was explained to me.

Normal vision involves the eye, which is basically just a device for capturing light, working in tandem with the brain. Patterns of light received by the eye are then passed down the optic nerve to the brain where they are turned into useful information.

Normal binocular vision relies on the two eyes sending almost identical images to the brain. The very slight differences between the two images is what enables us to perceive depth, distance etc.

If there is a physical problem which affects the eyes unevenly (eg. weak eye muscles in one eye, one eye much more short-sighted than the other) then two images received from the eyes are so different from one another that the brain can't make any sense of them. In this case the brain simply shuts out the fuzzy image it gets from the weaker eye, and relies only on the image from the stronger eye.

This is a useful survival strategy in principle, but because the brain is so malleable in young children, the neural pathways that the brain would have used to interpret the images from the weaker eye simply waste away. If left to its own devices, the end result would be a complete shutdown of the connections between the poor eye and the brain, resulting in permanent blindness.

The plasticity of the brain in young children means that patching can reverse this process by forcing the brain to 'talk' to the weak eye again.

The pioneering work in amblyopia was done by Colin Blakemore in the 70s. He patched baby monkeys from birth on one eye, and showed that they effectively had no vision in that eye as adults (and became a lasting hate figure of the animal rights lobby in the process).

hth

Tinker · 09/09/2004 18:33

Feel guilty for casuing alarm here as it was my daughter who lost her eyebrow with the patching. It did grow back completely though. We got a material patch that slipped over her glasses from the clinic. The clinic will give you all your patches, you don't have to pay for them.

Also only wore patch for about 2 to 3 hours and day and after nursery/school - never there.

Also, not all squints are operable. I've been told that my daughter's isn't - and been told by about 4 different eye people (get confused with all the different titles for eye people) so assume that that is correct. But the glasses correct it perfectly. But she will always have to wear them, or contact lenses when she is older.

notadrop · 16/09/2004 22:54

My ds1 was 21/2 when we found out he had a cataract in 1 eye. Had no idea he had virtually no vision in that eye. After op. patched him for 3 years on and off. At one point managed to patch for 7hrs a day (at school) as this was the only place he'd wear it. Fabric patches that slipped over glasses with no gaps for peeking (essential) were quite successful in the early days - didnt like feeling of sticky patch on face. Only real progress made when patching 7hrs. 2hrs a day not enough in ds1's case. Stickers quite helpful - we used to let ds1 pick a sticker for the front of his patch every day ( the sillier the better) Ds1 8 yrs old now & thankfully patching days are over. I hope your dd adjusts to wearing her patch as her eyesight improves it will get easier.

Hausfrau · 17/09/2004 09:40

This reply has been deleted

Message withdrawn at poster's request.

foxinsocks · 17/09/2004 19:21

merry, dd has a girl in her class who has to wear an eye patch. Today, dd came home with the stuff they have made this week at school (she's 4) and in it was a decorated eye patch. She said they all had to make one and then they all pretended to be captain hook (with their eye patches on) and charged around the class. I imagine the idea was to make this little girl feel more comfortable because her mum had said that she had been crying every day after school because she looked different to everyone else and didn't want to wear it.

Apparently, this 'group' eye patch wearing did make a difference to her and she seems a bit better now at not pulling it off (maybe it just takes a bit of time).

I'm not sure how old your dd is but maybe it's worth having a word with the nursery and seeing if they can make it into a game to ease her into it all (and then I guess the idea is that they don't notice it after a while!).

I hope it's all going well.

woodstock · 04/10/2004 05:34

Here is a link to the study I mentioned:

patching

woodstock · 04/10/2004 19:18

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