Patching Confusion

there is *a lot* of confusion about this, especially on the internet. when to "patch" & when not to, what patching is for & what its not for and how it works (and how it DOESN'T work).

1st of all NO ONE should patch any eye on their own. you really need an optometrist to prescribe a patching regimen. you can't just patch an eye randomly & hope for might even cause damage!

let's talk about what patching is: whenever an eye is poorly developing, usually in children under 8, patching is sometimes used to help that eye "catch up" in visual development/acuity. the patch is placed over the GOOD eye (or "better" eye) in order to FORCE the brain to "pay attention" to the "bad" or worse eye.

here's what patching CAN do:

- increase the acuity of an amblyopic eye, especially if instituted before age 8.

here's what patching DOES NOT do:

- "straighten" an eye thats turned (strabismus)
- "strengthen" a muscle thats "weak"
- reduce refractive error
- "lift" an eyelid thats droopy (thats not "lazy eye", thats "ptosis")
- make your vision "perfect" in the bad eye
- replace glasses or contact lenses as a form of vision fact patching ONLY works when the "bad" eye is wearing the BEST POSSIBLE PRESCRIPTION WHILE THE "GOOD" EYE IS PATCHED.
- fix "blindness"...amblyopia is not "blindness". a "blind" eye will not benefit from a patching regimen. FREQUENTLY patients with retinopathy or corneal conditions or macular degeneration will try to improve the vision of their "bad" eye by patching the good eye...NO. stop.

ONLY patch under DIRECT supervision of an optometrist, and ONLY while you are wearing the best possible glasses/contacts Rx. do not patch on your own, and patching does not "replace" vision correction


  1. Is it possible to prevent the lazy eye from moving involuntarily?

  2. not with a patch. if its moving IN and its from uncorrected farsightedness...YES glasses will help. if its moving out or up or down...unlikely to be able to prevent it from moving those directions w/o surgery

  3. I'm pretty confused about my son's eye problems. Do you mind answering a few questions, if possible? I've asked his eye dr these questions, trying to understand it better but he always gives me such vague answers, then some conflicting answers during this last check-up. Background - we first took my son to the eye dr when he was almost 2 because his left eye was turning in. The dr said he was farsighted & prescribed glasses (distance +4 sph on right & left). He's been wearing these glasses 2 years now, with regular checks-ups in between. He's really good about wearing them & the dr has said to stick with the same prescription. When he's wearing his glasses, his eye does not turn inward. When he's not wearing glasses, it does turn inward. Will his glasses - or a surgery - eventually correct his vision? If it's corrected, will the eye still turn inward or is that eye going to turn inward the rest of his life? I'm asking because it's such a prominent physical feature & I hate to think of him having to deal with this stigma concerning his looks. I know this sounds overly dramatic but I'm a mom - I can't help it! It was my impression that farsightedness was different than lazy eye & his eye dr told me over a year ago that it was NOT lazy eye. This year I asked him again & I was explaining to him that I have a lazy eye but I was not treated at a young enough age to correct it. I asked him to clarify the difference between my lazy eye and my son's eye turning inward. At that point, the eye dr said that my son's issue IS lazy eye (caused by farsightedness) and he asked me if we could get him to wear a patch and that we "only have a year left to do it." I'm kind of upset thinking that we could have been using the patch as a correction all this time and he wouldn't even have told me it was an option if I had not pressed him for an explanation about lazy eye. What is your take on this? And one more thing - he told me to patch his eye for 2 hours a day. Is this the "minimum" time he should wear a patch? Or should I have him wear the patch as often as I can? Is there any over-doing it with the patching? Thanks so much for any help you can give me. I just want to understand what I can do to help my son.

  4. all valid/legit questions:

    "When he's not wearing glasses, it does turn inward. Will his glasses - or a surgery - eventually correct his vision?"

    no. the fix is wear glasses (or later contacts) most or all the time. his eyes will always turn in w/o the glasses on. IF his eyes are NOT TURNED IN with the glasses ON...he is not a candidate for any surgery. not strabismus surgery, not lasik, etc. so no. no surgical procedure will "correct his vision". he's gonna be in glasses or contacts.

    "or is that eye going to turn inward the rest of his life?"

    yes. his eyes will turn inward for the rest of his life...when glasses or contacts are OFF. this is called "accommodative esotropia"

    "At that point, the eye dr said that my son's issue IS lazy eye (caused by farsightedness)

    lazy eye or amblyopia is an eye that cannot see 20/20 even with the best glasses/contacts. patching could help a lazy eye. if your son has 1 eye that is not 20/20 thru the +4.00 glasses, he probably needs to be patching the other eye a few hrs a day.

    lazy eye is NOT a turned eye. thats different. a turned eye CAN CAUSE a lazy eye, but they are not the same thing. this is why most docs don't like or use the term "lazy eye". patients are way too confused over what it is & what it isn't. you'd be better off to just stop using that term altogether. if your eyes turn in, thats esotropia. if your eyes turn in from being farsighted, thats accommodative esotropia (not a surgical case). if your eyes turn in/out/up/down and you are not farsighted at all thats strabismus (and needs surgery). if your eye is not 20/20 thats amblyopia (and could benefit from patching).

    "And one more thing - he told me to patch his eye for 2 hours a day. Is this the "minimum" time he should wear a patch? Or should I have him wear the patch as often as I can? Is there any over-doing it with the patching?"

    when i was patched as a kid it was supposed to be all day. 8+ hrs. recent studeis have proven that most kids only need about 2 hrs/day to force the brain to stop suppression & increase acuity. almost no one recommends more than 2 hrs/day of patching anymore. so no - don't bother with trying to get him to wear a patch for more than 2 hrs/day. no added benefit, only added frustration. you can't "over-do" it, but you don't get any added benefit by wearing it 8 hrs vs 2 hrs. same benefit.

    this is all very confusing & i'm sorry you're having to deal with this. it sounds like you've had pretty appropriate treatment, tho. don't be too upset over the "new" idea to patch...measuring acuity in a 2-7 year old is not easy. maybe your doc just realized at a recent exam that one eye is not 20/20 & decided to add patching. its doubtful that he knew all along that 1 eye was not going to reach 20/20 & just decided not to patch.

  5. Thank you so much! The way you explain things is very thorough & understandable. I'm sad for him that he'll always have an eye that turns inward, but hey, I've lived my whole life with vision in only one eye. It could be worse. Thanks again :)

  6. I was told that I have astigmatism, which is causing my left eye to be droopy. I have been told that it is ptosis. What is it? I will ask an opti surgeon. If it is astigmatism, how can I fix the droopy eyelid?

  7. there is some confusion here...
    a droopy eyelid is ptosis, not astigmatism.
    you may also have astigmatism, but astigmatism does not "cause" ptosis. those 2 are separate things, not related to one another.

    ptosis can only be "fixed" by having a surgical eyelid "lift".

  8. Hi,
    My son was detected with Lazy eye , just 4 days back.He turned 10 last month.Will Patching and vision therapy help him in any way, as he has crossed the age of improvement.I am really desperate to know.Could u please some exercises which he can do at home? Hee was detected with 20/400 vision on his right eye and 20/20 on his left eye.He never complained before, I took him to check his eyes as he recently complained of headaches.
    I would really appreciate any feedback from you.Thank you so much.I live in Kuwait wher there are no, Vision therapy centers how, can I help from home,in close contact with Optimetrists.

  9. it really depends on multiple factors: if the amblyopia and 20/400 vision is from a congenital cataract, pthisis, phthisis, or some optic nerve disorder, then no...patching won't do anything. If the amblyopia is from strabismus or refractive error, that must be addressed FIRST with appropriate glasses, contacts, prism, surgery, etc...THEN you could try patching (the good eye) a few hrs a day and see if you get any improvement. Some imprivement could probably be made at age 10, but not as much as if the patching had been implemented before age 8


Post a Comment

Popular Posts