Published: 2019-01-25

A unique solution to improve an amblyopic child’s adherence to patching

Dora H. Alharkan


Amblyopia should be treated in early ages to have better outcomes. Stimulation of suppressed eye and depriving light stimulus to the good eye is the main principal of the amblyopia treatment. Adherence to the patching for the treatment of amblyopia in children remains challenging. This could be due to poor cooperation of child or ill-fitting patch. Younger children can be motivated to mimic cartoon figures to improve their adherence to patching. Amblyopia treatment is a team work of parents and optometrist who not only select the mode of management but improve the acceptance of child for patching.  We present a child with mild anisometropia and hypermetropia-induced esotropia and amblyopia who was non-compliant to patching. An innovative idea by the parents using a Ninja Turtle patch on the prescribed spectacle was very well accepted by the child and both esotropia and amblyopia improved within four months of the patching treatment. The vision in the affected eye improved from 20/200 to 20/20 with refractive error correction and patching. We share this low-cost child-friendly patching technique that parents invented that can be used to improve adherence to patching by young children during amblyopia therapy. This parent’s innovation enabled to improve adherence and thus address amblyopia in patched eye and regain vision.


Amblyopia, Eye-patch, Squint

Full Text:



Li J, Thompson B, Lam CS, Deng D, Chan LY, Maehara G, et al. The role of suppression in amblyopia. Invest Ophthalmol Visual Sci. 2011;52(7):4169-76.

Pascual M, Huang J, Maguire MG, Kulp MT, Quinn GE, Ciner E, et al. Risk factors for amblyopia in the vision in pre-schoolers study. Ophthalmol. 2014;121(3):622-9.

Caputo R, Frosini R, De Libero C, Campa L, Del Magro EF, Secci J. Factors influencing severity of and recovery from anisometropic amblyopia. Strabismus. 2007;15(4):209-14.

Maconachie GD, Farooq S, Bush G, Kempton J, Proudlock FA, Gottlob I. Association between adherence to glasses wearing during amblyopia treatment and improvement in visual acuity. JAMA Ophthalmol. 2016;134(12):1347-53.

Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmol. 2003;110(11):2075-87.

Fielder AR, Irwin M, Auld R, Cocker KD, Jones HS, Moseley MJ. Compliance in amblyopia therapy: objective monitoring of occlusion. Br. J Ophthalmol. 1995;79(6):585-9.

Boyd K, Lipsky SN. Amblyopia: Lazy Eye Treatment. American Academy of Ophthalmology. Eye-Health A-Z. 2017. Available at: Accessed 13 May 2018.

Stewart CE, Moseley MJ, Georgiou P, Fielder AR. Occlusion dose monitoring in amblyopia therapy: status, insights, and future directions. J AAPOS. 2017;21(5):402-6.

Vagge A, Nelson LB. Compliance with the prescribed occlusion treatment for amblyopia. Curr Opin Ophthalmol. 2017;28(5):454-9.

Cutler DM, Everett W. Thinking outside the pillbox-medication adherence as a priority for health care reform. New Eng J Med. 2010;362(17):1553-5.

Stewart CE, Stephens DA, Fielder AR, Moseley MJ. Objectively monitored patching regimens for treatment of amblyopia: randomised trial. BMJ. 2007;335(7622):707.

Tjiam AM, Asjes-Tydeman WL, Holtslag G, Vukovic E, Sinoo MM, Loudon SE, et al. Implementation of an Educational Cartoon ("the Patchbook") and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia. Strabismus. 2016;24(3):120-35.

Faith MS, Van Horn L, Appel LJ, Burke LE, Carson JA, Franch HA, et al. Evaluating parents and adult caregivers as “agents of change” for treating obese children: evidence for parent behavior change strategies and research gaps: a scientific statement from the American Heart Association. Circulation. 2012;125(9):1186-207.