Occlusion of the contralateral eye is known to benefit vision in most amblyopic eyes, however the success of occlusion is at the mercy of compliance. When home patching has failed, and cycloplegic penalization is not satisfactory, in-patient patching or occlusive contact lens use has proven beneficial. We are concerned about the safety of the better eye during prolonged contact lens use, especially in rural Alaska.
In an IRB-approved protocol for non-compliant amblyopes, shield occluders were fashioned from heat-moldable sturdy black or translucent (20/4000) plastic with holes drilled for attachment. Under brief general anesthesia, patients aged 5-10 had a thorough exam under anesthesia before the shield occluder was sewn to the brow and cheek of the non-amblyopic eye with 3-0 Prolene monofilament suture.
Ten individuals completed this protocol from summer 1999 through July 2001. All tolerated the occluder for 3-5 weeks. The amblyopic eyes improved from 0.77±0.3 logMAR (20/119) to 0.45±0.29 logMAR (20/57), a change of 0.32±0.15 logMAR lines. There was no damage to the better, occluded eye. The resultant skin scars were acceptable to parents, patients and investigators.
Sew-on occluder shields are an alternative when compliance with other types of patching is not satisfactory.