At age 32 I decided I would start patching my good eye to fix my strabismus induced lazy eye (strabismic amblyopia). I was immediately bombarded with arguments for and against patching. So I started researching.
Will Patching fix my lazy eye? Patching has been proven in countless studies over the last several hundred years to strengthen visual acuity and other visual skills in the weaker eye in patients with deprivation, refractive, and strabismic amblyopia, or lazy eye. Although it can strengthen the weak eye, it does not teach the eyes to work together to create binocular vision or stereopsis.
Patching is not exactly enjoyable, so it’s important to make sure that it can help you get the results you’re looking for before you immerse yourself in patching therapy.
What Type of Doctor Treats a Lazy Eye?
Ophthalmologists, Optometrists and Developmental Optometrists all treat lazy eye (Amblyopia). I highly recommend making an appointment with one (or all three) before you start any sort of patching routine.
A Professional can give you a diagnosis and understanding of how your eyes work. They will most likely know if a patch will be effective for you. Some are biased though, so don’t just take the first opinion that you get!
For Amblyopia treatment, Ophthalmologists typically recommend patching 2-6 hours a day depending on severity. They also prescribe glasses with prisms or the correction needed to help the eyes work in ideal circumstances.
For Strabismic Amblyopia patients they generally perform surgery in conjunction with patching and glasses. They have produced plenty of research to prove that this is the best way.
Although there are exceptions, most Ophthalmologists believe that Vision Therapy is a complete waste of time and money.
Traditional Optometrists are very similar in their approach to Ophthalmologists, many times they will refer their Amblyopia patients to an Ophthalmologist or Developmental Optometrist.
Developmental or Behavioral Optometrists (the ones who do vision therapy) also have plenty of research, but theirs says that patching should be replaced with in-office vision therapy. They use patching as a part of treatment many times, but for only short periods of time when done in conjunction with near exercises during vision therapy.
I feel like the truth is definitely somewhere in the middle because all of these groups of professionals are getting results. I feel like Ophthalmologists get started in the right direction and Vision Therapy finishes it off in a way that will last forever.
Will Patching Fix My Lazy Eye?
Once you go to one of the different types of eye doctors, you will know your specific diagnosis which will shed light on whether patching will be effective for you.
Lazy Eye is a term for a condition called Amblyopia. There are 3 different common types of Amblyopia.
- Refractive Amblyopia happens when a person has reduced vision in one eye that causes the brain to ignore it. So if you have a 20/20 prescription in one eye and 20/200 in the other, the brain just ignores the 20/200 eye and only uses the 20/20 eye. Over time the weak eye looses it’s ability to focus and the visual acuity gets even worse. The weak eye can eventually go blind if nothing is done.
- Deprivation Amblyopia is usually caused by cataracts, but can be caused by anything that deprives an eye of seeing well or normally. A cataract is when a cloudy area in the lens of the eye prevents normal vision in that eye. The good eye then takes over and the weak eye continues to get worse, until it could potentially become blind.
- Strabismic Amblyopia occurs when your eyes are physically misaligned because of Strabismus. Since the eyes don’t point in the same direction, they get a different picture which can cause double vision. The brain doesn’t like double vision so it ignores one of the eyes. Eventually, the ignored eye becomes weak, looses visual acuity and wanders further.
When I read about these, they all feel like pretty similar outcomes, with different causes. One eye is strong, one eye is weak. If the weak eye continues to be ignored, it will eventually become blind or just more terrible.
The Main Problems that Need to be Potentially “Fixed” in Amblyopia:
- Strengthen the weak eye’s visual acuity (prescription)
- Improve the weak eye’s ability to focus, track and other visual skills
- Prevent an eye from going blind
- Straighten a turned eye
- Teach the eyes to work together to gain 3D vision or stereopsis
Patching is amazing at fixing 1-3, but not so much at 4 and 5. Let’s take a deeper look into how patching actually helps fix a lazy eye.
1-Strengthen the Weak Eye’s Visual Acuity (prescription)
There are hundreds of research studies that show that patching improves visual acuity. These are mostly focused on Refractive or Deprivation Amblyopia and work towards determining how Amblyopia patients should patch and whether exercises during patching create better results.
The researchers take a group of people with Amblyopia and have some patch 2 hours a day, others 6 and see who improves the most during a specified period of time. They all improve though, whether it’s by 2 lines or by .5. It’s not even a question on if they will improve with patching, the question is, how much and how quickly will they improve.
It is important to also note that you will eventually reach a plateau, when patching can no longer help and improve. This is where Vision Therapy can take you to the next level.
2-Improve the weak eye’s ability to focus, track and other visual skills
This is where I’m looking because I technically have 20/20 vision. That is always funny to hear, because my right eye sees the world in a blurry sort of way. This is because although I have good “acuity,” my right eye needs help with all the other visual skills (there are 17 visual skills!).
If you patch and stare at a blank wall, it will probably not do much. But if you patch and do exercises to enhance focus, tracking and other visual skills, there will be major improvements in your weak eye that will bring your eyes to an equal playing field with each other.
3-Prevent an eye from going blind
Consistent daily patching according to a doctor’s orders, can definitely prevent blindness in relation to amblyopia. It keeps both eyes involved and at the very least, maintains the vision in the weak eye so that the vision can’t get worse.
4-Straighten a Turned Eye (Strabismus)
Patching alone, in the vast majority of cases, will not straighten a turned eye in a noticeable way. Patching improves vision in the weak eye which creates an atmosphere where the eyes can learn to see together. But patching cannot accomplish this by itself.
Patching is an important part of the process in straightening a turned eye, but alone, it will not get you all the way there. I have been patching for 6 months and my eye has remained the same in terms of the degree of turn. It is much stronger, but the turn is the same.
5-Teach the Eyes to Work Together to Gain 3D vision (Stereopsis)
Some patients with Amblyopia experience stereopsis all the time, others intermittently, and some never. If you have had 3D vision in the past, strengthening the vision in your weak eye through patching could potentially bring it back or maintain and improve it.
For the rest of us who have never had 3D vision, patching will only be a part of the solution. Intensive Vision Therapy will be required to reach full time stereopsis. Some people say it is impossible, but I’m not one of them
The purpose of patching is to strengthen the host of visual skills needed to see well in a weak eye. This generally is a good fit for people who have one strong eye and one weak eye.
If both of your eyes can already see well, just not together, patching is not going to change anything. You are already to a point where vision therapy can help you get your eyes working together so that they can eventually straighten and have stereopsis.
My Personal Story with Patching
I was born with Strabismus which lead to Amblyopia and patched all through my childhood. The combination of patching, prism glasses and surgeries “fixed” my eyes according to my Ophthalmologist. Fixed meant that I looked normal, but my eyes did not actually have stereopsis so they weren’t at all working together.
Over the next 10 years my eyes were straight most of the time, but my right eye would wander occasionally. It kept getting worse until I realized that my right eye was always off to the side and not being used at all.
It was August of 2018 when I decided that it was time to fix my lazy eye. My optometrist suggested patching 4-5 hours a day and I obediently followed. I hadn’t even heard of Vision Therapy at this point in my life.
The first few weeks were eye opening for me. I realized that the vision in my lazy eye was terrible even though it was supposedly 20-20. I walked with my hands out for the first week or two to try to prevent collisions with doors, walls and people. I couldn’t read and everything was blurry. My head throbbed anytime I was wearing the patch. The most difficult part was that my brain was working so hard to see out of that eye, there wasn’t room for anything else. I was forgetful and clumsy and messed up who knows how many recipes.
After about 6 weeks of patching for 4 hours each day, I wasn’t seeing any results worth mentioning. I was frustrated and searching for answers and help. I prayed, was this even worth my time and effort, was healing even possible for me?
The answer came while attending a meeting at my church, The Church of Jesus Christ of Latter Day Saints. A challenge was issued by our Prophet to read The Book of Mormon before the end of the year. He promised that miracles would happen if we did. I felt a very overwhelming spiritual feeling. The very distinct impression came to my mind, “if you will do this, you will see a miracle; your eye will be healed.” It was so powerful, yet peaceful.
I started reading while patching my good eye and continued for the next 3 months. It took me about an hour a day and I started seeing results almost immediately. I gained the ability to control my lazy eye, which had never been possible before. Instead of always using my left eye to see, I could use either eye, my right eye was so much stronger!
I understand that all of you probably don’t have the same beliefs as I do, which is totally fine, but I mention this because reading scripture everyday has helped in two main ways:
1: Reading is an amazing exercise for your eyes, especially for a weak eye. My lazy eye got an hour of intense exercise everyday and it showed. By the end of the year, patching became easy. No headaches, I could see much better out of my weak eye, and my brain could multitask again even while patching. Reading combined with patching is awesome!
2. Inspiring literature is exactly that: inspiring. Patching is much more than a physical feat, the emotions involved are a force to be reckoned with. whether it’s insecurities, doubt, frustration, fear, or hopelessness, there are some definite negative emotions involved with eye treatment. You need a daily dose of inspiration to buoy you up. Maybe your version will be the bible, inspiring quotes, or novels about people who defy unimaginable odds. Find something inspiring and read it while you patch!
Patching absolutely made a difference for me. I have since discovered Vision Therapy and have added a few things into my eye routine. But patching was and remains an imperative part of the journey for me.
Anytime I miss a day or two, I notice a huge difference. My weak eye looses what it has gained so quickly, this tells me that patching is definitely making a difference.
Before you can retrain your brain to use both eyes, you have got to have two good eyes worth using. This can be accomplished through patching.
How Long Should I Wear a Patch for my Lazy Eye
Recent research has shown that patching for 2 hours a day when combined with at least 1 hour of near activities or vision therapy produced results that match groups who patched for 6 hours a day. This works well for moderate Amblyopia (20/100 or better), but more time, up to 6 hours could be prescribed for severe Amblyopia (20/100 and worse).
What are the Side Effects of Patching too Long?
In the early years of life your brain learns how to combine input from both eyes for binocular vision. If one eye is constantly patched, it disrupts the brain’s ability to combine the messages from both eyes and can cause long lasting issues with stereopsis and other visual issues.
Check out Google Scholar to see the plethora of studies done regarding Amblyopia and patching, here is one that was particularly interesting:
- This Study compares patching with near activities against just using glasses for Amblyopia patients. The patching group improves twice as much!