To patch or not to patch?

For us, it isn’t the question. Recent studies have proven that vision therapy is a more effective treatment.

Patching has been used for years to help patients diagnosed with amblyopia or strabismus, both often called “lazy eye”. However, recent evidence and clinical practice suggests there may be better alternatives. An active program of vision therapy has been clinically proven to provide optimal results.

Wearing a patch over one eye has historically been used to attempt to treat people with amblyopia or strabismus. Strabismus is the medical term for a “crossed eye,” when there is a problem with the eye alignment and the eyes do not look at the same place at the same time.


Amblyopia, commonly called a “lazy eye,” most often occurs when the brain is unable to form a single image from the individual information given from each eye, and subsequently “suppresses” or ignores information from one eye. This results in one eye having less visual acuity than the other eye, among many other deficits, such as reduced accuracy of focussing and reduced ability in tracking. Doctors prescribe wearing an eye patch over the better seeing eye in order to force the patient to use the weaker or crossed eye. While this may improve the function of the “lazy” eye, it doesn’t directly treat the issue: the brain’s inability to use the two eyes simultaneously. Rather, patching aims to passively improve one eye and hopes that the brain will figure out the rest on its own. This often leads to variable or limited results. Vision therapy, on the other hand, actively trains binocular visual processing to address the problems of amblyopia and strabismus directly at the cause.

Success rates of different treatment regimens for the divergence excess type of intermittent exotropia have been reported as follows: 59% for orthoptics/ vision therapy, 43% for surgery, and 30% for passive therapy like patching.

Learn more about why vision therapy leads to better results:

Active, Not Passive, Learning

Vision therapy is an active program of care that engages your eyes, brain, and body, while a patch is more passive. Because of this, the chances of a lazy eye recurring is lower with vision therapy than with patching, and vision therapy results in greater vision gains and shorter duration of treatment . 25% of children who patch have a recurrence within the first year of treatment, and that number is higher when families stop patching abruptly rather than tapering off.

Vision therapy

doctor led vision clinic

Doctor-Led Treatment

During a program of vision therapy, an experienced developmental optometrist is by your side, training your eyes what to do and teaching you why. If you want to learn to ride a bicycle, you don’t start by only pedaling with one foot at a time, keeping the other foot of the pedals. You have someone showing you the process, explaining what you need to do, and helping you start at the right level for you so that you can ride the bicycle safely and effectively.

Builds Neural Pathways

Vision therapy actively trains the brain how to use the eyes and builds new neural pathways that will serve you for the rest of your life. Vision therapy applies the latest methods and knowledge of neuroplasticity and visual function to help patients develop or regain the essential visual skills necessary for learning and optimal daily function. During a program of vision therapy, we address deficits in eye-teaming, focusing, visual tracking, visual processing problems, and other related visual problems.

How neuroplasticity works


Works With Both Eyes

When compared to patching, vision therapy leads to greater binocular visual acuity. Patching relies on the hope that the brain will pick up the correct way to use the eyes together, but vision therapy engages both eyes and the brain. It helps them develop more normal 3D vision, giving them better depth perception, eye hand coordination, and other functional visual skills.

More Confidence

It can also be hard to get a child to wear a patch, either because of their age or because they don’t like the way it looks and feels. A study showed that only 54% of participants actually patched as much as they were prescribed. They might be self-conscious about having to wear a patch in public, and it becomes another battle a parent has to wage. Vision therapy helps build skills and boost confidence, without having to wear something uncomfortable. A vision therapist is a cheerleader, encouraging and engaging a child. We aim to build up their vision and their confidence.

If you suspect that you or a loved one have amblyopia or strabismus, they should be evaluated by a developmental optometrist to prevent the lifelong struggles that come with these diagnoses. A developmental optometrist, like Dr. Jesse Willingham, can diagnose them during a thorough evaluation that goes beyond a routine eye exam. This additional testing allows the doctor to fully understand the underlying problem and better address the issue. Based on the diagnosis, he can recommend a treatment that best meets the patient’s needs.

Optometric vision therapy is an effective, non-invasive method for treating both amblyopia and strabismus. Vision therapy teaches your brain to better communicate with your eyes to more efficiently understand and navigate your world. It gets to the root of the problem and teaches the eyes to work together with the brain. While younger children can be more adaptable, individuals can take steps to treat amblyopia or strabismus at any age. Adult patients may have longer programs than children. Each person and program is unique!

Connect with us to see if we can open up a whole new world for you or your loved one!