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Occlusion Therapy in Children: Influence on Life Quality

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Girl with an eye patch

The population’s prevalence of amblyopia is 3–5%. Treatment approaches before the age of eight include glasses and eye patching (occlusion therapy). The latter requires wearing a patch over the healthier eye for several hours a day. In this blog, we discuss the effect eye patching or occlusion therapy has on children. Moreover, we will suggest a new alternative to avoid the bad consequences of eye patching. 

Challenges and Concerns Associated with Eye Patching in Children

Some eye patches cause itching, pain, and allergic reactions. When the patch is removed, the area around the eye patch may become painful and red. Furthermore, the patch may also make it difficult to perform daily tasks, including writing, viewing at schoolboards, coloring, painting, playing, and recognizing obstacles, because we “penalize” the better-seeing eye.

What is more, children may experience social rejection and bullying as a result of wearing a patch. During occlusion, these factors may reduce the child’s quality of life. However, children’s and parents’ perspectives of decreased quality of life differ.

Scientific Research: Parental Concerns vs. Children’s Experiences

In research from van der Sterre et al. (2022), 60 children and 56 parents were included (2022). Results showed that occlusion therapy had less of an impact on children’s quality of life than it did on their parents’.

When a child’s better eye gets patched, parents often feel sorry for the child. The children only argued that they felt the patch on their eye. Furthermore, they were only slightly impacted by experiencing pain when the patch was removed. When they were coloring, making puzzles, watching TV, playing computer games, and doing other activities, they caused little bother.

Low initial visual acuity in the amblyopic eye had little impact on quality of life during occlusion; the 13 children with VA 0.6 ≥ logMAR in the amblyopic eye at the beginning of occlusion had no problem using the computer, coloring, or solving puzzles. However, between start and finish, the worse eye’s visual acuity had increased.

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Between the beginning of the occlusion and the interview, the visual acuity of the worse eye had improved by an average of 0.24 logMAR. Parents remembered the difficulty with initiating the occlusion a few months earlier, while the children focused on their current quality of life based on the enhanced visual acuity.

Anger, Pain, Itching?

However, parents and children were of similar opinions about the presence of emotions like anger and the awareness of the need to patch.

They didn’t agree when it came to reporting pain or itching during the skin contact of an eye patch or problems with eye-hand coordination.

Nevertheless, it’s likely that children downplayed their discomfort or difficulty with coordination in an effort to appear more brave. Children with amblyopia brought on by refractive error and strabismus had the lowest quality of life overall and the worst visual acuity in the affected eye.

Eye patching therapy has such impact on life quality it can provoke emotions like anger.

Lasting Psychological Effects After Eye Patching Treatment

Research from Guimarães et al. (2019) observed if psychological effects associated with occlusion therapy in children lasted even after the treatment. They found no evidence to confirm that the effects are long-term. Researchers discovered a lower self-perception of social acceptance was significantly correlated with patching in amblyopic children.

Patching can result in short-term distress for both children and their families (2019). However, Choong and associates did not discover any variations in stress levels between amblyopic kids treated with and without patching. Like spectacles, you can find patches in a variety of colors and shapes. They have gained in popularity and social acceptance.

So, What is the Influence on Life Quality of Occlusion Therapy?

To conclude, in most cases, parents perceive occlusion therapy as having a stronger influence on their children than they do. This is probably due to increased awareness of their surroundings and the possible consequences for their child’s social inclusion.

Children are not bothered by their surroundings. They are more aware of the sensation of wearing and removing the eye patches, which can be a bit distracting. Most of the time, they are not disturbed in their daily activities or are not aware of the restriction.

What is the New Alternative for Eye Patching?

Nevertheless, there are a lot of drawbacks because wearing a patch might have negative social and psychological effects that make compliance issues arise. Because of the shortcomings of eye patching therapy and the discomfort associated with decreasing a child’s visual field, parents have found it difficult to adhere to it.

Gamified Vision Therapy That Uses Binocular Stimulation

Gamification in Amblyopia Treatment

Gamification, when applied to therapeutic vision therapy, serves as a powerful tool to enhance engagement, motivation, and ultimately, treatment outcomes. By integrating game-like elements such as rewards, challenges, and progress tracking into vision therapy sessions, several benefits emerge.

Firstly, gamification makes therapy sessions more enjoyable and interactive. Traditional vision exercises can sometimes feel repetitive and tedious, leading to decreased motivation and adherence. Furthermore, gamification can personalize the therapy experience to suit individual needs and preferences.

Binocular Stimulation (Dichoptic Therapy)

Even though amblyopia is a binocular condition that has long been understood, monocular vision has always been the main emphasis of the conventional method.

Among all available amblyopia treatments, one really effective active treatment approach for amblyopia is binocular dichoptic therapy.

Firstly, dichoptic vision therapy takes advantage of the brain’s neuroplasticity—the ability to reorganize and adapt—by stimulating both eyes simultaneously with different visual inputs. Dichoptic therapy stimulates both eyes at the same time and teaches them how to work together.

This approach encourages the brain to integrate information from the amblyopic eye and the stronger eye, promoting binocular vision and improving visual function.

By training both eyes to work together, dichoptic therapy directly targets the fundamental issue of interocular suppression, where the stronger eye dominates visual processing while the weaker eye is suppressed.

Get your AmblyoPlay Vision Therapy today!

AmblyoPlay vision therapy presents an ideal solution for amblyopia treatment by combining the benefits of gamification with dichoptic therapy. By integrating game-like elements into dichoptic vision exercises, AmblyoPlay offers an engaging and interactive approach to amblyopia treatment.

This gamified experience not only makes therapy sessions more enjoyable but also enhances motivation and adherence, leading to more consistent and effective treatment outcomes.

With its ability to provide personalized treatment plans and harness neuroplasticity, AmblyoPlay vision therapy stands out as the right choice for individuals seeking an effective, engaging, and comprehensive approach to amblyopia treatment.

Frequently Asked Questions

What are the common challenges associated with eye patching in children undergoing occlusion therapy?

Eye patching in children undergoing occlusion therapy can pose challenges such as itching, pain, and allergic reactions. The removal of the patch may result in pain and redness around the eye. Additionally, daily tasks like writing, viewing schoolboards, coloring, and playing may become difficult due to the temporary penalization of the better-seeing eye.

How does wearing an eye patch affect the quality of life for children undergoing eye patching therapy?

The use of eye patches during occlusion therapy can impact a child’s quality of life. It may lead to social rejection and bullying, affecting the child’s overall well-being. However, perspectives on the decreased quality of life may differ between children and their parents.

How do children with amblyopia caused by refractive error and strabismus compare in terms of quality of life and visual acuity during occlusion therapy?

Children with amblyopia caused by refractive error and strabismus tend to have the lowest quality of life overall and the worst visual acuity in the affected eye. However, the research suggests that the impact on quality of life during occlusion may be less significant than initially perceived.

Sources:
1. Choong YF, Lukman H, Martin S, Laws DE. Childhood amblyopia treatment: psychosocial implications for patients and primary carers. Eye (Lond) 2004;18:369-75.
2. Guimarães, S., Carção, A. A., Carvalho, M. R., Vieira, M. J., Freitas, C., & Morgado, P. (2019). Quality of life and mental health in amblyopic children treated with and without occlusion therapy. Journal of American Association for Pediatric Ophthalmology and Strabismus, 23(6), 339.e1-339.e5. https://doi.org/10.1016/j.jaapos.2019.09.009
3. van der Sterre, G. W., van de Graaf, E. S., van der Meulen-Schot, H. M., Abma-Bustraan, E., Kelderman, H., & Simonsz, H. J. (2022). Quality of life during occlusion therapy for amblyopia from the perspective of the children and from that of their parents, as proxy. BMC Ophthalmology, 22(1). https://doi.org/10.1186/s12886-022-02342-w

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Why Do We Suggest a Minimum Time of 6 Months for Success?

Based on the data from over 15,000 patients using AmblyoPlay, improvements start within 4 months, while optimal results take anywhere between 6-18 months on average. The duration of required training depends on the patient’s age, the severity of the problem, accompanying diseases, and adherence to the training program.