Patching is hard.  It a topic that shows up over an over on the facebook group, as parents try to figure out the best way to encourage their kids to keep the patch on.  And the stakes are high: one of the biggest predictors of success with patching is how well your child does at patching for the recommended time.  (We’ve had some fantastic posts here with a lot of tips and tricks, and Amblyopia Kids has some great advice, too).

Turns out, it’s not just parents that are interested in this question.  I recently ran across a series of articles by researchers in Europe (mostly, the Netherlands) that looked at a variety of methods to improve compliance in amblyopia treatment (references and links below).

The researchers looked at three different methods to help families with patching.

• A calendar and stickers for the child.
• A leaflet for the parents explaining amblyopia and it’s treatment
• An educational cartoon designed for the child to explain amblyopia and the importance of patching

The children were 3 to 6 years old, and all had amblyopia and were prescribed patching as treatment.  The researchers were looked at how long each child patched each day, and whether there were any days that they didn’t patch at all – that was measured electronically with a monitor on the patch that can tell when the patch is being worn.

All three of the methods improved the amount of time, and the number of days patched, compared with children who used none of the methods.  And those children also saw better improvements in acuity and shorter treatment periods.  Among the three methods, children given the cartoon had the best results, with the parent’s leaflet being in second, and then the calendar and stickers.

So what does that mean for us?  The three methods that were studied are not particularly new or groundbreaking, and fortunately, they’re not particularly difficult to do at home.   It is clear that it is important that parents understand why they need to patch their child, but even more importantly, our children need to understand why they are patching as well.  I would advise all parents who need their children to wear a patch for amblyopia to educate themselves on the importance of treatment, to set up a rewards chart for their child, but most importantly, to help their child understand why they are patching.

I wish I could find the cartoon they used in the study, it’s described as

 … a cartoon story, without text, as most of the children treated for amblyopia are too young to read. The cartoon depicts the orthoptic examination of a preschool child, subsequent patching therapy, and the reasons for therapy seen from the perspective of the child. As no animal figures were included, the children were more able to identify themselves with the child depicted in the story. The cartoons could not be linked to a certain ethnic or cultural group. (Loudon et al, 2006 [full text])

While I couldn’t find the cartoon described above, I think this speaks to the need for more books about amblyopia and it’s treatment.  If you look at our page of books, there’s very few out there that talk about patching at all, and not all of those talk about the reasons for treatment.  So here’s my call to arms!  All you aspiring children’s book writers, especially those of you with kids who have amblyopia…  Write!  Please!  We need more books for our kids!

This is not the cartoon used in the study, but when I found it, I knew I had to include it. It was published in 1968 by the US Department of Health, Education, and Welfare. Click on the image to get to the full cartoon, part of the Government Comics Collection hosted by the University of Nebraska-Lincoln

References

S. E. Loudon, M. Fronius, C. W. Looman, M. Awan, B. Simonsz, P. J. van der Maas and H. J. Simonsz, 2006. “Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor,” Investigative Ophthalmology & Visual Science, vol. 47, 4393-4400. [full text]

A. M. Tjiam, G. Holtslag, H. M. Van Minderhout, B. Simonsz-Toth, M. H. Vermeulen-Jong, G. J. Borsboom, S. E. Loudon and H. J. Simonsz, 2012. “Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents,” Graefe’s Archive for Clinical and Experimental Ophthalmology. [abstract]

A. M. Tjiam, G. Holtslag, E. Vukovic, W. L. Asjes-Tydeman, S. E. Loudon, G. J. Borsboom, H. J. de Koning and H. J. Simonsz, 2012. “An Educational Cartoon Accelerates Amblyopia Therapy and Improves Compliance, Especially among Children of Immigrants,” Ophthalmology. [abstract]