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Occlusion therapy in children: influence on life quality

Girl with an eye patch

The population’s prevalence of amblyopia is 3–5%. Treatment approaches before the age of eight years include glasses and eye patching (occlusion therapy). The latter requires wearing a patch over the healthier eye for several hours a day. Some eye patches cause itching, pain, and allergic reactions. The area around the eye patch may become painful and red once the patch is removed. 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.

In research from van der Sterre et al., 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 and that 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. However, 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. 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.

Research from Guimarães et al. 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 that was significantly correlated with patching in amblyopic children when compared to age-matched controls. 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, patches are now offered in a variety of colors and shapes and have gained in popularity and social acceptance.

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 patch, 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.

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