Patching — the original Vision Therapy
Patching ain’t easy. It’s hot, sticky, unfair. No one likes only using one eye. No one likes the potential social stigmas. Not parents nor the patching child. So, why not just go the vision therapy route — and forget about all this patching nonsense?
If you are a parent of a patcher who contends with the daily frustrations of getting a patch on, keeping it on, waiting for the next eye doctor exam to tell you if there is improvements — then you may likely have also tried out some facebook parenting support groups, or blogs for parents of kids who patch. That’s where the idea for this blog post was born. It literally happened to me twice that I posted or replied on one of these sites and found myself the recipient of a vision therapy fan’s tyrannical rant. I have literally been told I am a terrible parent for making my child patch. Yes- they told me it is child abuse to inflict patching on my daughter. This happened without knowing my child’s diagnostic, that we had indeed tried vision therapy, or knowing if my family could even afford vision therapy.
Recently I saw one such debate on one of these not so supportive support groups and the woman aggressively promoting vision therapy really made me think. Maybe it was her assumptive/condescending manner? Or maybe I just perpetually long for parents to support and empathize with other parents with open minds? But I didn’t love what I saw in the lineage of comments. One poor mom was posting about her struggles with patching, she and her son were new to patching and she was looking to hear about other parents’ experiences. Basically after a few encouraging comments with insightful advice, one woman commented to forget all about it and do vision therapy. The mom new to the whole amblyopia experience replied asking what it was. The other mom launched into how she would never use a “black out” method for her child and directed the other mom from this patching support group to a vision therapy parents group. Maybe her intentions were purely good? Maybe this is just quintessential internet trolling? It just seemed more self serving than well intended help. Maybe I misread it? In any case — I have seen enough similar instances that I thought maybe breaking it all down right here could be helpful.... helpful to those new to the concept, helpful for those considering all options, and helpful to those promoting options that may not be for everyone.
I am not a doctor.
This post does not serve to advise anyone.
I am sponsored by neither an optometrist nor an ophthalmologist.
I have seen both.
I understand some procedures/processes are different in other countries- I can only write this from a perspective of having this experience in the USA
The descriptions of vision therapy are MY OPINION. If you disagree, your research or experience may have been different. I have tried to write this in the most unbiased way I could
I believe all parents need to do what they believe is right for their child, regardless of my experience.
In most cases —Wearing an occlusion eye patch is used to strengthen a weak eye. It is used to cover a stronger eye, so that it cannot be used for the duration of time it is under a patch. This allows the weaker eye to work harder, to strengthen itself. This process also allows for the brain/ weaker eye connection to further develop and work together better than before.
To me — this sure does sound a bit like training both the brain and the eye to work better.
Patching is in most cases prescribed by a pediatric ophthalmologist who will test acuity, retinal health, the optic nerve, color blindness, a range of lens issues... lets say vision as well as overall eyeball health. As a parent, in my experience, the visits to the pediatric ophthalmologist felt very thorough. To me, it felt that if patching was prescribed from there, it was from a well informed, well rounded opinion, it came from a doctor who cared about the overall well being of my child’s vision and eye health.
After about a year and a half of patching and having impressively positive results, there seemed to be a plateau. There was also a great deal of resistance from my daughter. She was becoming older and the struggles to get a patch on were not only metaphorically, but truly bolder, louder, stronger.
I remember it was summer and because school was out we were spending more time together. Sometimes, you are with your own children so much, you cannot notice subtleties. My dad did. Eddy is such a sweet natured girl. Any time we would go places it is natural to hold a six year old’s hand. She was not usually one to run off, likely cautious from earlier years of seeing less. My dad noticed she would always find an adult hand to hold. In particularly, if while we were walking she would notice a change in terrain. If we were going from paved road to gravel sidewalk, or sandy beach. He noticed that she would often be scanning to see what was ahead and it became predictable she would find a hand. Having a toddler, it wasn’t always my hand she searched for, as she knew my hands were literally full.
My dad pointing this out to me made me think a great deal about depth perception and how it will be for eddy to adjust one day to using both eyes, as she spends all days patching almost the entire day - 8 hours. I began watching her and seeing if I could find signs of any depth perception issues. There really weren’t any, unless you count ball sports. That could also just be a lack of exposure one could blame on me.
Coincidentally I had just seen a fascinating Ted Talk about vision therapy. Like a sign or omen, I hadn’t researched it, it was just the next one that popped up after I had finished some other one.
The ted talk planted a seed. That coupled with a family friend who was an optometrist who suggested vision therapy. So, like any parent obsessed with how to make decisions for their child’s health— I went on a full blown research mission about vision therapy. I mean - if you knew how I research even a coffee maker if I want to buy one... then you can only imagine the endeavor of my altering the course of how we were going improve my daughter’s vision by considering vision therapy.
I went as far as to call the center for vision therapy in Massachusetts which this woman, Sue Barry, on the TED Talk spoke about. I would go there if I had to. If vision therapy could change her vision in her 50’s, why shouldn’t I did dictate the time to do this for my daughter.
By scouring internet articles and reading different vision therapy websites, I learned about what it was. I read vision therapist bios, philosophies, programs. It did not matter where that vision therapy center was, I just read about what they had to offer. I called many of them as well.
I learned they are not everywhere. They are not accessible to all communities. (I know of one family who had the grandmother drive their son 1.5 hours each way!)
They are not covered by insurance.
They are not in line with ophthalmologists’ views on treating amblyopia.
There seemed to be three types - unofficially.
The general idea behind vision therapy is to help the brain and the eyes work together. There is a disconnect between the two for most children diagnosed with strabismus/amblyopia. The theory is that the activities done at vision therapy will develop that muscle memory, so to speak. This allows the eye and brain to communicate seamlessly. Our eyes do the seeing and our brains do the interpreting — they need to work together, most of us have that happen easily for us. Children who patch do not.
Because each family and diagnosis is unique, the existence of varying philosophies within Vision Therapy is good, so more families can utilize vision therapy. As I see it, here are the three types.
The first one would be the vision therapist who does not want you to continue a relationship with your ophthalmologist. The way they will treat your child is to ask you to discontinue the patching. This is the way they treat it, it cannot be combined with other methods. I have read about great successes with this endeavor. It is a commitment and both the child and parent must adhere to the schedule and exercises that accompany the method.
The second one I found was centers that would gladly take a large sum of your money and they would tell you which iPad games to play. They are of course therapy, these games.... but it didnt seem to me the answer I was looking for. I have mixed feelings about screen time in general. I understand that many games require a bit of actual exercise for the eyes, if you will. Naturally there is a fine motor skill component, along with ongoing brain interpretation of what the eye is seeing, often a moving object. My daughter is more than happy to spend time on a tablet/computer/ or any video game. I didn’t think I needed to spend thousands to do that.
The third one I found was a nicer middle ground, in my opinion. Often the vision therapists understand you have a relationship with an ophthalmologist and there was no talk of iPad games. The patient visits the therapists the prescribed amount of times per week. While there they do various exercises- physical sometimes, written, and a bit of fine motor skill/hand eye coordination activities.
I often like to treat a head cold with vitamins and herbs. My husband goes straight for the over the counter drugs. It seems, we both now start with the vitamins and herbs, and utilize the industrial strength stuff as needed as well. I like to think marrying homeopathic and traditional medicines can yield good results. So, I imagined, maybe if we go to vision therapy as well as patch — we can kick some amblyopia ass and be done with it all the sooner!
The third approach I wrote about above seemed best for me. We were not ready to “break up” with our pediatric ophthalmologist or go cold turkey on patching. While I may be a bit all or nothing in most aspects of my life, I felt that to turn this decision into a fork in the road moment, would be too much of a gamble for me.
As it turned out, as luck would have it, the third type which was middle ground, was the only single one that existed in the state I live in, and was only ten minutes from our home. Seems like an easy enough decision.
It will be $10,000 for 9 month of treatment.
No insurance reimbursement.
No one to watch my 3 year old while we go there. (3x a week for 9 months)
More driving in traffic.
And MORE homework.
I really wanted to try this vision therapy option out. I wanted to give Eddy another way to work on making her vision stronger. However, it wasn’t looking like an easy out for patching. It was over budget and it created child care dilemmas. And I was learning there are definitely members of the ophthalmological community that find vision therapy, for a lack of better words, a quack.
So, I agonized about the decision for vision therapy. We had a great pediatric ophthalmologist who I trusted cared greatly for my daughter’s vision. I would not imagine she wants her to patch, which is hard, just because. But I also wanted to try everything, do everything I could to save her vision. I also want financial security for the long road ahead. Would paying this large sum of money to a practice not covered by insurance be a smart financial decision for my family? I stress this element of the decision because most families do not have that much additional cash available. And yet most families do want to provide everything they can for their children, especially medical treatment. Vision therapy is expensive, making it not available to all families. It is not covered by insurance because there have not been enough case studies to support it. The ones I have seen have mostly been successful, so maybe one day it will be covered? But, for now, it is not. When I read the comments in the above mentioned support groups, I wonder if those advocating for vision therapy recognize, it may just not be in everyone’s budget?
It was a hard decision. Our ophthalmologist’s feelings on the matter was another challenging element in our decisions. Our pediatric ophthalmologist was less than enthusiastic. We were open and honest with her that we wanted explore this route. She was diplomatic and explained that she usually did not encourage it and reminded us it is out of pocket to treat this way. I do not need our doctors endorsement, but I do trust her and did not want to damage the relationship we had with her.
It was also a huge time commitment going to vision therapy three times a week plus homework, plus ten thousand dollars. Could my family pull this off?
We are wildly fortunate and my parents offered to help with paying for vision therapy. They wanted to see us try to do everything we could to help Eddy. If we had not had their encouragement, I’m not sure we would have been able to try it at all.
We live in Honolulu where traffic is very bad, as it is in most cities. Vision therapy was about an hour. Getting the girls from their school to vision therapy and home was an additional hour an half of driving to my day. Luckily or not, I was not working, as I m not sure what job would allow you to take 3 hours off mid day. It also involved keeping my three year old entertained for the hour... Three days a week. Each week we would get a new folder with homework. Eddy had to do her vision therapy homework each night for about 15-20 minutes. It was usually activities like letter searching or putting small objects through straws. It almost always involved parental involvement. Eddy also had homework from school. She was in first grade so it wasn’t a lot of homework, but there was homework and reading. VT added to that part of our family evening routine. It may sound laborious or like complaining. That is not so, we feel tremendously lucky that we found the type of vision therapist we wanted and we had financial support. I list the details as I am trying paint a vivid picture here of what vision therapy is.
About six or seven months into vision therapy we had our regular three month pediatric ophthalmologist appointment. Eddy’s vision had improved so greatly that we wound up having to alter the prescription for her glasses. As most readers here might know, that usually only occurs annually. This was a big deal for us. We cannot say if the vision therapy was why? Did we make it past a patching plateau? The combination really is working?
As we made it towards the 8 or 9 month mark of vision therapy, the vision therapist wanted to change Eddy’s eye glasses prescription. I agonized over this decision. As I understood it, our pediatric ophthalmologist has always kept her Rx slightly under allowing her to see 20/20. This was done to keep the eyes working at trying to see, to further minimize the farsightedness. I think her glasses generally allow her to see at 20/30. The vision therapist wanted her rx to allow her to see at 20/20. The fact that there was a discrepancy between the eye specialists, made for a hard decision. What I ultimately did was fulfill one set of frames with the vision therapists recommendation, and leave her other set alone. She used the vision therapist’s prescription glasses for reading. As we were approaching the end of first grade, I really needed her to have more reading confidence. They were only used for reading at home, and I actually think that helped her academically. It was likely an hour or less a day, but they served their purpose.
After another three months Eddy finished with vision therapy. We had met the goals we had set with the vision therapist when we started. She completed with a trophy and overall a lot of confidence from the experience. We also had another ophthalmologist appointment. We talked about it with her and told her the experience was done. I believe she was being honest and our ophthalmologist conceded that maybe the vision therapy did help? I doubt she is recommending this to other patients? But I do think our sharing the experience with her has given her a more open mind to it.
Everyone considering vision therapy has a different reason, a difference diagnosis, a different goal, and a different budget. Many towns cannot even offer it. Some families cannot drive an hour or more to it. With that said, it can be a worthwhile endeavor if you have a cooperative child.
Ultimately, what I concluded was neither is fail safe endeavor for families. Patching is not easy. But neither is vision therapy. There were many days my daughter did not want to go. It meant missing the beach, quitting swim team for a year, and not having after school play dates for a year. Families have to put the work in to both of them to yield the results.
If vision therapy is a method in which to make the eye and the brain train together so they can work better together, what is patching? Patching trains one eye to work harder to catch up with the other. This is not a scientific description - but - if one eye is communicating and working better with the brain it is dominating use of the brain. Patching helps so that good eye can take a time out so the brain has some time to work with the weaker eye.
What I am saying, again- I am not a doctor. But, if you injure your knee and eventually go to physical therapy for rehab, you are working to strengthen the muscles and use them the correct way. One could easily apply that explanation to either patching or to vision therapy. There are certain successes in patching and in vision therapy. There are challenges to both as well. As parents we do the best we can to fix problems for our children as swiftly as we can.
Being a parent faced with the choices of VT or patching is not a simple place to be. But working at all to try to make the vision and the eyes better is the goal. Respecting varied methods seems to make sense. I would love to see more case studies and vision therapy become covered for the families who want to have it. Ideally, maybe doctors and vision therapists could start working together more and the length of time these patchers have to work can become less.
I recognize I have not laid any hard claims here on the pros or cons of either. But I do hope I helped to see that the benefit of being actively involved with your patcher is going to yield the greatest results.
What are your experiences with patching and vision therapy? What are your thoughts?