Occlusion therapy for children with amblyopia doesn't affect their quality of life or ability to do daily activities as much as parents may think. Photo: Bisant Labib, OD. Click image to enlarge.

Young patients with amblyopia are sometimes treated via occlusion of the better eye involving eye patch wear for several hours a day, although the method has been speculated—often by parents—to significantly impact a child’s quality of life. Though this may still be true for some patients, a recent study presented evidence showing that amblyopic children are actually affected much less by occlusion therapy than their parents might think.

The researchers developed the Amblyopia Parents and Children Occlusion Questionnaire, consisting of 12 items concerning skin contact of patch, activities, contact with other children, emotions and awareness of the need to patch. Sixty children (38 male) ages eight or younger, along with their parents, were recruited by orthoptists to fill out the survey. Parents completed a proxy version, while patients completed a child version. On average, the children wore a patch for an average of 128 days before the interview, and 54 wore glasses prior to occlusion therapy.

After comparing questionnaire responses between children and their parents, the results showed that children judged their quality of life better than their parents did, particularly when it came to skin contact and activities such as playing games and watching TV. Thirteen children with initial visual acuity in the amblyopic eye of ≥0.6logMAR reported experiencing no trouble with games during occlusion. However, the researchers pointed out in their paper that “the visual acuity of the worse eye had improved between the start of occlusion and the interview by, on average, 0.24logMAR. Hence, it can be argued that the children made a judgment about their current quality of life on the basis of the improved visual acuity,” they wrote.

Notably, the researchers did find that in children aged five years and older, quality of life correlated negatively with the angle of strabismus. This finding aligns with previous research done by the study authors that found that quality of life in adults 35 years of age with amblyopia or strabismus is heavily influenced by visual acuity of the amblyopic eye. Also of note: children with the lowest quality of life, reported by both the patients and their parents, were those with amblyopia due to refractive error and strabismus (n=14).

“Children and parents, as proxy, largely agreed in their report about non-observable emotions of anger and awareness of the necessity to patch,” the researchers noted in their paper. “They disagreed in their report on pain or itching during skin contact of the patch and trouble with performing eye-or-hand tasks.” They added that it is possible, however, that “the children presented themselves as more brave by underreporting the pain or trouble in eye or hand tasks.”

Several of the children with amblyopia also did not know why they needed to wear a patch, although most parents believed that their children knew the reason. Children reported failing to inform their parent(s) if they forgot to patch, which the parents confirmed.

In conclusion, the questionnaire responses from amblyopic children and their parents found that occlusion therapy may not have as much of an impact on a child’s day-to-day life as is often perceived.

van der Sterre GW, van de Graaf ES, van der Meulen-Schot HM, et al. Quality of life during occlusion therapy for amblyopia from the perspective of the children and from that of their parents, as proxy. BMC Ophthalmol. March 25, 2022. [Epub ahead of print].